Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Foveal Tear Repair in the United States Military

Abstract

Purpose: To compare subjective and objective midterm functional clinical outcomes of knotless arthroscopic assisted transosseous (AAT) triangular fibrocartilage complex (TFCC) repairs specifically in a cohort of military service members. Methods: Patient charts were reviewed to identify all cases of TFCC repair by a single surgeon from 2012 to 2016. Primary outcome variables were the QuickeDisabilities of the Arm, Shoulder, and Hand score and return to full military duty. Secondary outcome variables were visual analog scale for pain, Mayo Modified Wrist Score, Single-Assessment Numeric Evaluation, and the number of push-ups in 2 minutes during a record physical fitness test. Inclusion criteria were adult active duty service members who underwent AAT TFCC repair with a minimum of 2 years' follow-up. Terminal follow-up was determined by a telephone interview. Exclusion criteria were distal radioulnar joint instability, revision procedures, cases involving other ligamentous repair procedures, and those with an incomplete medical record or who could not be reached for the survey. Results: Fifteen patients, average age 21 years (range, 18e29 years), met inclusion and exclusion criteria with mean follow-up of 3.8 years (range, 2e5.9 years). Average QuickeDisabilities of the Arm, Shoulder, and Hand score was 9.7 (range, 0e29.5) and 93% were able to remain on active duty. Average secondary outcomes scores were: visual analog scale ¼ 1.3 (range, 0e4); Single-Assessment Numeric Evaluation ¼ 87.3 (range, 30e100); Mayo Modified Wrist Score ¼ 84.3 (range, 55e100); and push-ups ¼ 72 (range, 42e90) in 2 minutes. One patient required a secondary surgery. Conclusions: Knotless AAT TFCC repair may be a safe and effective procedure that may return military service members to a preinjury level of activity. Type of study/level of evidence: Therapeutic IV.

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

“…49 Five studies listed DRUJ instability as an exclusion criterion. 27,[37][38][39]44 In Badia and Khanchandani, DRUJ instability was an indication for a different approach of repair than the one studied. 27…”

“…26,40,48 Fourteen studies reported peripheral TFCC repairs [26][27][28][29][30][31][32][33][34][35][36][37][38][39] and 13 studies reported foveal avulsions of the TFCC. [40][41][42][43][44][45][46][47][48][49][50][51][52] As the pathoanat-omy of these tears and repair techniques differ, the outcomes of peripheral and foveal tears were analyzed separately.…”

“…Seven papers reported a transosseous repair technique. 40,[44][45][46][50][51][52] Iwasaki et al performed arthroscopicassisted transosseous repair using a guiding device through the four to five portal, targeting the fovea. An outside-in technique for the suture shuttle was then utilized, with the sutures finally tied onto the ulnar periosteum over the proximal entrance of the osseous tunnel.…”

“…40,51 Dunn et al performed the reattachment in a similar technique, securing the TFCC in a horizontal mattress, tensioning through the tunnel and fixed it with a suture anchor proximal to the bone tunnel. 44…”

“…43 Only one patient needed a complete re-operation of his TFCC repair due to re-injury from boxing 4 months following the initial procedure. 44 In 14 patients (10 with open approach, four arthroscopically), ECU tendonitis was noted in follow-up and required exploration and tenosynovectomy. 26 Two studies-both using the arthroscopic approach-reported suture removal in five patients due to irritation.…”