Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

Abstract

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

All –arthroscopic Repair of Atzei Class II and III Triangular Fibrocartilage Complex Tears Using the Fast-fix Suture Device

“…The all-arthroscopic technique using a pre-tied suture device in peripheral TFCC tear was rst published by Yao et al in 2007 [20]. Long-term report at a mean 7-year follow-up in Palmer IB lesion without gross DRUJ instability exhibits promising outcome [21]. We adapt this pre-tied suture device for use in the treatment of peripheral TFCC tear with proximal component involvement.…”

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

“…Three papers were comparative studies and included two study groups. 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.…”

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

“…Miwa et al proceeded to surgery after 2 months with persistent "unendurable pain." 9 Tang et al, 10 Kim et al, 11 Sarkissian et al, 12 and Iwasaki et al 13 all moved to surgery after 3 months with Iwasaki et al using a removal wrist brace for immobilization. Ruch and Papadonikolakis 14 and Infanger and Grimm 15 proceeded after at least 4 months of conservative management and Papapetropoulos et al, 16 Bayoumy et al, 17 and Millants et al 18 utilized 6 months of conservative management with splinting and anti-inflammatories prior to surgical intervention.…”

“…In our review, 16 articles were found focusing specifically on outcomes of arthroscopically repaired 1B lesions with a total of 409 patients undergoing repair. [11][12][13][16][17][18][38][39][40][41][42][43][44][45][46][47] For the 16 articles, four different scoring metrics were reported (Disabilities of the Arm, Shoulder, and Hand [DASH], Mayo, visual analog scale, and personal scoring system) and not every article reported pre-and postoperative values. Additionally, not all reported range of motion (ROM), pain, or return to work status.…”

“…DASH score was the most reported with an overall average improvement from 40.2 to 14.8 in 10 articles. 12,13,17,18,40,42,[44][45][46][47] Return to work was the second most common outcome discussed in eight of the articles, 13,18,[39][40][41][42][43]46 showing that in this group with an average age of 33, only 68% were able to return to work. Six articles specifically addressed pain 13,18,38,41,42,45 of the patients, persistent pain was noted in 52 (40.9%), though an additional 34 were noted to have a "reduction in pain" which was not specified regarding full resolution.…”