Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

Liu, Edward H.; Suen, Kary; Tham, Stephen; Ek, Eugene T.

doi:10.1055/s-0040-1718913

Cited by 27 publications

(23 citation statements)

References 54 publications

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“…This study is designed to evaluate arthroscopic synovectomy for the treatment of rheumatic wrist arthritis. Wrist arthroscopy is a minimally invasive procedure often used by wrist surgeons to diagnose post-traumatic wrist pathology, repair ligament tears and resect ganglion cysts [ 44 – 46 ]. Earlier studies have demonstrated improvement of wrist function and pain after arthroscopic synovectomy in RA patients [ 17 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial)

d'Ailly

Deugd

Schep

et al. 2023

Trials

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Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. Methods This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0–100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. Discussion Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. Trial registration Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. ClinicalTrials.gov NCT04755127. Registered after the start of inclusion on 15 February 2021.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial)

d'Ailly

Deugd

Schep

et al. 2023

Trials

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“…[18][19][20][21] However, advances in wrist arthroscopy have allowed for all-arthroscopic repair, with good functional outcomes. 9,10 In line with these results, open repair of TFCC 1B lesions was selected by only 1% of respondents in this survey. Different methods for performing TFCC repair were not included in this survey because of the large number and rapid development of new techniques.…”

Section: Triangular Fibrocartilage Complex Injuriesmentioning

confidence: 99%

“…Recent studies have shown that arthroscopic repair of TFCC injuries leads to good clinical and patient-related outcomes. 9,10 Likewise, improvement of wrist function has been demonstrated following reconstruction of SLL injuries, 11 for which several arthroscopic suturing and anchoring techniques have been described. 6,12,13 The number of published papers in PubMed on the topic of wrist arthroscopy has doubled since 2010 and is now well over 2,000.…”

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confidence: 99%

The Current Role of Arthroscopy in Traumatic Wrist Injuries: An Expert Survey

et al. 2022

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Background Wrist arthroscopy has become increasingly popular for diagnosing and treating traumatic wrist injuries. How wrist arthroscopy has influenced the daily practice of wrist surgeons remains unclear. The objective of this study was to evaluate the role of wrist arthroscopy for the diagnosis and treatment of traumatic wrist injuries among members of the International Wrist Arthroscopy Society (IWAS). Methods An online survey was conducted among IWAS members between August and November 2021 with questions regarding the diagnostic and therapeutic importance of wrist arthroscopy. Questions focused on traumatic injuries of the triangular fibrocartilage complex (TFCC) and scapholunate ligament (SLL). Multiple-choice questions were presented in the form of a Likert scale. The primary outcome was respondent agreement, defined as 80% answering similarly. Results The survey was completed by 211 respondents (39% response rate). The majority (81%) were certified or fellowship-trained wrist surgeons. Most respondents (74%) had performed over 100 wrist arthroscopies. Agreement was reached on 4 of the 22 questions. It was agreed that the outcomes of wrist arthroscopy strongly depend on surgeons' experience, that there is sufficient evidence for the diagnostic purposes of wrist arthroscopy, and that wrist arthroscopy is better than magnetic resonance imaging (MRI) for diagnosing TFCC and SLL injuries. No agreement was reached on the preferred treatment of any type of TFCC or SLL injury. Conclusion There is agreement that wrist arthroscopy is superior to MRI for diagnosing traumatic TFCC and SLL injuries, yet experts remain divided on the optimal management. Guidelines need to be developed for the standardization of indications and procedures. Level of Evidence This is a Level III study.

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“…In the repair methods, pull-out suture showed greater biomechanical resistance in comparison with the anchor technique 3 and overall better functional outcomes were reported using a transosseous suture compared with suture anchors. 19,20 The other important perspective is that the remnants of torn pc fibers usually retract, fibrose, and absorb in chronic cases. Therefore, approximation and maintaining its position by simple suturing cannot guarantee biological healing.…”

mentioning

confidence: 99%