Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries

Crowe, Christopher S.; Kakar, Sanj

doi:10.1302/0301-620x.105b1.bjj-2022-0908.r1

Cited by 3 publications

(2 citation statements)

References 42 publications

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“…Atzei and Luchetti (2011) further described the myriad of TFCC injuries and classified isolated foveal tears as a Class 3 injury, detectable by DRUJ arthroscopy. Crowe and Kakar (2023) further classified these injuries into partial and complete foveal tears, with and without DRUJ instability. All patients in this study demonstrated an arthroscopically confirmed foveal tear, and yet only five patients had DRUJ instability and 19 of the 24 patients had stable DRUJs upon clinical examination.…”

Section: Discussionmentioning

confidence: 99%

“…Unless present with a combined central tear (Minhas et al., 2022), the foveal insertion of the TFCC can only be visualized via DRUJ arthroscopy. Given that, we advocate for the routine use of DRUJ arthroscopy, especially if there are concomitant pathologies, such as central tear or ulnotriquetral ligament injury, to assess for the location and completeness of the foveal insertion of the TFCC (Crowe and Kakar, 2023).…”

Section: Discussionmentioning

confidence: 99%

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Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury

Welling,

Kakar

2023

J Hand Surg Eur Vol

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The primary aim of the present study was to present a case series of 24 patients with foveal triangular fibrocartilage complex (TFCC) injuries that were treated with arthroscopically assisted TFCC foveal repair. In total, 19 patients had a stable distal radioulnar joint (DRUJ) and five had an unstable DRUJ. Despite this, all patients were found to have a foveal tear upon DRUJ arthroscopy. Magnetic resonance imaging (MRI) scans detected only eight out of 23 patients with foveal injuries. In addition to their foveal injury, 19 of the 24 patients had additional pathology that required treatment. At a mean follow-up of 18 months, there was a statistically significant improvement in pain, range of motion, grip strength and functional scores. In this study, we demonstrate that having a stable DRUJ upon clinical examination and normal MRI findings does not rule out foveal TFCC injury and a high index of clinical suspicion is needed when managing patients with ulnar sided wrist pain. Level of evidence: IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury

Welling,

Kakar

2023

J Hand Surg Eur Vol

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Magnetic Resonance Imaging Assessment of Ulnar Wrist Pain: A Practical Guide for Surgeons

Crowe,

McKenzie,

Kakar

2024

The Journal of Hand Surgery

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Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex

Cho,

Lee,

Kim

et al. 2024

Bone Joint J

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AimsThe study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes.MethodsA retrospective analysis was conducted on patients arthroscopically diagnosed with Palmer 1 A lesions who underwent arthroscopic debridement and partial excision from March 2009 to February 2021, with a minimum follow-up of 24 months. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Wrist Score (MWS), and visual analogue scale (VAS) for pain. The poor outcome group was defined as patients whose preoperative and last follow-up clinical score difference was less than the minimal clinically important difference of the DASH score (10.83). Baseline characteristics, arthroscopic findings, and radiological factors (ulnar variance, MRI, or arthrography) were evaluated to predict poor clinical outcomes.ResultsA total of 114 patients were enrolled in this study, with a mean follow-up period of 29.8 months (SD 14.4). The mean DASH score improved from 36.5 (SD 21.5) to 16.7 (SD 14.3), the mean MWS from 59.7 (SD 17.9) to 79.3 (SD 14.3), and the mean VAS pain score improved from 5.9 (SD 1.8) to 2.2 (SD 2.0) at the last follow-up (all p < 0.001). Among the 114 patients, 16 (14%) experienced poor clinical outcomes and ten (8.8%) required secondary ulnar shortening osteotomy. Positive ulnar variance was the only factor significantly associated with poor clinical outcomes (p < 0.001). Positive ulnar variance was present in 38 patients (33%); among them, eight patients (21%) required additional operations.ConclusionArthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. The presence of positive ulnar variance was associated with poor clinical outcomes, but close observation after arthroscopic debridement is more likely to be recommended than ulnar shortening osteotomy as a primary treatment.Cite this article: Bone Joint J 2024;106-B(4):380–386.

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Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries

Cited by 3 publications

References 42 publications

Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury

Foveal triangular fibrocartilage complex pathology: a potentially under-recognized injury

Magnetic Resonance Imaging Assessment of Ulnar Wrist Pain: A Practical Guide for Surgeons

Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex

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