Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents

Abstract

To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE). Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome. Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings. Level IV, therapeutic case series.

Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

“…If the patients were not contactable or refused to participate in the study, the last clinical follow-up was used [ 23 , 24 , 25 ]. Three studies had at least one prospective clinical follow-up [ 26 , 27 , 28 ]. The overall study quality was very low with MINORS criteria ranging from 10 to 13 and the Modified Coleman Score (MCS) ranging from 34 to 56.…”

“…The overall study quality was very low with MINORS criteria ranging from 10 to 13 and the Modified Coleman Score (MCS) ranging from 34 to 56. Six papers reported solely on pediatric and adolescent cases [ 23 , 24 , 25 , 27 , 28 , 29 ], whereas two studies also reported adult cases [ 26 , 30 ]. Terry and Waters [ 29 ] and Wu et al [ 25 ] reported both open and arthroscopic cases, with data of the former being fully extractable.…”

“…Two studies reported only cases with arthroscopic repair [ 27 , 30 ]. One study reported cases with only arthroscopic debridement [ 28 ]. Most authors used statistical analysis for both pre- and postoperative patient-reported outcome scores wherever available [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“…A clear history of a wrist trauma was reported for 163 patients (64.1%). Palmer’s TFCC tear classification was used in six studies [ 23 , 24 , 25 , 27 , 28 , 29 ]. The most common injury types reported were Palmer types 1B ( n = 140, 54.1%) and 1D ( n = 40, 15.4%).…”

“…X-ray examinations were obligatorily used by five studies [ 23 , 24 , 25 , 29 , 30 ]. Only Farr et al (2018) [ 28 ] did not specifically report any preoperative examination algorithm. The majority of patients underwent conservative treatment before opting for surgery.…”