Laser-Assisted Wrist Arthroscopy and Triangular Fibrocartilage Debridement

Abstract Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal. Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal. Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured. Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case. Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

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Revolutions in arthroscopic wrist surgeries

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211030861 ◽

2021 ◽

pp. 175319342110308

Author(s):

Toshiyasu Nakamura ◽

Pak Cheong Ho ◽

Andrea Atzei ◽

Fernando Corella ◽

Jan-Ragnar Haugstvedt

Keyword(s):

Bone Graft ◽

Arthroscopic Surgery ◽

Wrist Arthroscopy ◽

Scaphoid Nonunion ◽

Arthroscopic Reconstruction ◽

Palmaris Longus ◽

Transosseous Repair ◽

Technological Developments ◽

Triangular Fibrocartilage ◽

Advanced Treatments

Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. In this review, world leaders of wrist arthroscopy describe bone graft for scaphoid nonunion, transosseous repair for triangular fibrocartilage fovea avulsion, palmaris longus reconstruction of the triangular fibrocartilage, and arthroscopic reconstruction of the scapholunate and lunotriquetral ligaments.

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The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415624669 ◽

2016 ◽

Vol 41 (5) ◽

pp. 516-520 ◽

Cited By ~ 4

Author(s):

K. Kasapinova ◽

V. Kamiloski

Keyword(s):

Distal Radius Fracture ◽

Distal Radius ◽

Triangular Fibrocartilage Complex ◽

Distal Radius Fractures ◽

Radius Fracture ◽

Wrist Arthroscopy ◽

Radius Fractures ◽

Level Of Evidence ◽

Triangular Fibrocartilage ◽

A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

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Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415622342 ◽

2016 ◽

Vol 41 (7) ◽

pp. 732-738 ◽

Cited By ~ 11

Author(s):

J. K. Andersson ◽

P. Axelsson ◽

J. Strömberg ◽

J. Karlsson ◽

J. Fridén

Keyword(s):

Joint Instability ◽

Clinical Signs ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Independent Observer ◽

Radioulnar Joint ◽

Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

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Anatomic Reconstruction of the Triangular Fibrocartilage Complex for the Treatment of Chronic Instability of the Distal Radioulnar Joint. A Systematic Review

Revista Iberoamericana de Cirugía de la Mano ◽

10.1055/s-0041-1736570 ◽

2021 ◽

Vol 49 (02) ◽

pp. e97-e104

Author(s):

Ignacio Miranda ◽

Francisco J. Lucas ◽

Vicente Carratalá ◽

Joan Ferràs-Tarragó ◽

Francisco J. Miranda

Keyword(s):

Systematic Review ◽

Surgical Techniques ◽

Case Series ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Anatomic Reconstruction ◽

Wrist Arthroscopy ◽

Radioulnar Joint ◽

Druj Instability ◽

Triangular Fibrocartilage

Abstract Introduction Peripheral injuries of the triangular fibrocartilage complex (TFCC) can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the reconstruction of the TFCC. The aim of the present paper was to summarize the tendon plasties of the DRUJ ligaments for the anatomic reconstruction of TFCC, to analyze the surgical techniques, and to evaluate their outcomes. Methods In order to perform a systematic review, we searched in the literature the terms DRUJ instability OR chronic distal radioulnar joint instability OR distal radioulnar tendon plasty. Results In total, 11 articles with level of evidence IV (case series) were retrieved. Most studies achieved good results, with recovery of wrist stability, improvement of the pain, and increase in grip strength in the functionality tests. In the historical evolution of the published series, wrist surgeons tried to perform a more anatomical plasty, with a more stable fixation and less invasive techniques. Conclusion The Adams procedure continues to be a valid and reproducible technique for the treatment of chronic DRUJ instability. If wrist arthroscopy and implants are available and surgeons have been technically trained, the authors recommend an arthroscopy-assisted technique, or, if possible, an all-arthroscopic TFCC reconstruction with implant fixation of the plasty in its anatomical points of insertion. Comparative studies between open and arthroscopic TFCC reconstruction techniques are needed.

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Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/s0749-8063(98)70075-1 ◽

1998 ◽

Vol 14 (5) ◽

pp. 479-483 ◽

Cited By ~ 79

Author(s):

JG Westkaemper ◽

G Mitsionis ◽

PN Giannakopoulos ◽

DG Sotereanos

Keyword(s):

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Triangular Fibrocartilage ◽

Complex Injuries

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Atraumatic Bucket Handle Abnormality of the Triangular Fibrocartilage Complex in an Adolescent

Journal of Wrist Surgery ◽

10.1055/s-0038-1669919 ◽

2018 ◽

Vol 08 (05) ◽

pp. 423-425

Author(s):

Leen Vanlaer ◽

Sebastiaan Kellens ◽

Maarten Van Nuffel

Keyword(s):

Congenital Abnormalities ◽

Incidental Finding ◽

Anatomical Variations ◽

Review Literature ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Articular Disc ◽

Traumatic Lesion ◽

Triangular Fibrocartilage ◽

Bucket Handle

Background Congenital abnormalities of the triangular fibrocartilage complex (TFCC) are rare and could be mistaken for a traumatic lesion. It is important to recognize these anatomical variations and to realize they do not always require treatment. Case Description An incidental finding of an atraumatic bucket handle abnormality of the TFCC in a 15-year-old male, who was treated arthroscopically for dorsal wrist pain. This structure was resected, thus obtaining a normal looking peripheral TFCC. Literature Review Literature regarding congenital abnormalities of the TFCC is limited to a meniscoid articular disc or a congenital perforation. To our knowledge, an atraumatic bucket handle abnormality has not been described yet. Clinical Relevance This congenital abnormality of the TFCC could be mistaken for a traumatic lesion on MRI, or during wrist arthroscopy; therefore, it is important to realize that this entity may occur and does not require treatment.

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The Carpal Detachment Injury of the Triangular Fibrocartilage Complex

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2001.0680 ◽

2002 ◽

Vol 27 (1) ◽

pp. 86-89 ◽

Cited By ~ 20

Author(s):

S. NISHIKAWA ◽

S. TOH ◽

H. MIURA ◽

K. ARAI

Keyword(s):

Soft Tissue ◽

Conservative Therapy ◽

Articular Surface ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Ulnar Side ◽

Arthroscopic Findings ◽

Triangular Fibrocartilage

Triangular fibrocartilage complex (TFCC) injuries were suspected clinically in 22 wrists of 21 patients, but arthrography and MRI assessments of this structure were normal. As conservative therapy for 2 months did not improve their symptoms, wrist arthroscopy was then performed. Although no abnormalities of the TFCC and ligaments were observed, meniscus homologue-like tissue which arose from TFCC was riding on the articular surface of the triquetrum. After resection of this soft tissue with a shaver and a punch, the symptoms disappeared in all cases. The arthroscopic findings suggested that a portion of TFCC that was originally attached to the ulnar side of the triquetrum had become detached.

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A Novel All-Inside Arthroscopic Technique for Radial-Sided Triangular Fibrocartilage Complex Tears: A Case Report and Review of Literature

Hand ◽

10.1177/1558944717715138 ◽

2017 ◽

Vol 12 (5) ◽

pp. NP166-NP169 ◽

Cited By ~ 1

Author(s):

Michael T. Edgerton ◽

Robert C. Kollmorgen

Keyword(s):

Case Report ◽

Range Of Motion ◽

Single Case ◽

Excellent Result ◽

Full Range ◽

Triangular Fibrocartilage Complex ◽

Wrist Arthroscopy ◽

Single Case Report ◽

Triangular Fibrocartilage

Background: Triangular fibrocartilage complex (TFCC) injuries are a known cause of ulnar-sided wrist pain. Wrist arthroscopy is the gold standard for diagnosis of these lesions and is becoming a more frequent method of treatment. Isolated radial-sided tears are uncommon and treatment of these lesions is controversial. There are few reports on repair techniques. Here we report on a novel arthroscopic, all-inside technique for traumatic radial-sided TFCC tears that resulted in full range of motion, significant improvement in pain, and ultimately return to sport. Methods: This is a single case report describing an all-inside, arthroscopic repair of a radial-sided TFCC tear. The techniques and postoperative protocol are discussed. Clinical outcomes were reported at final follow-up of 3.5 months. Results: At final follow-up, our patient had full wrist range of motion, 95% strength, occasional 1/10 pain, and returned to sport at her previous level of play. There were no complications. Conclusion: Although just a single case report, our patient had an excellent result based on modified Mayo wrist score. When comparing our result and the previous literature, this technique seems to be a valid method for addressing radial-sided TFCC tears.

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