Arthroscopic Debridement of Triangular Fibrocartilage Complex Tears

Background 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. Purpose The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. Materials and Methods 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). Results 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. Conclusion 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 of Evidence Level IV, therapeutic case series.

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Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears With Suture Welding: A Technical Report

Yearbook of Hand and Upper Limb Surgery ◽

10.1016/s1551-7977(08)70299-1 ◽

2007 ◽

Vol 2007 ◽

pp. 130-131

Author(s):

S.L. Moran

Keyword(s):

Triangular Fibrocartilage Complex ◽

Arthroscopic Repair ◽

Technical Report ◽

Triangular Fibrocartilage

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The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211024177 ◽

2021 ◽

pp. 175319342110241

Author(s):

I-Ning Lo ◽

Kuan-Jung Chen ◽

Tung-Fu Huang ◽

Yi-Chao Huang

Keyword(s):

Simple Procedure ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Ultrasound Assessment ◽

Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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Clinical evaluation of a wrist sensorimotor rehabilitation program for triangular fibrocartilage complex injuries

Hand Therapy ◽

10.1177/17589983211033313 ◽

2021 ◽

pp. 175899832110333

Author(s):

Zhiqing Chen

Keyword(s):

Grip Strength ◽

Outcome Measures ◽

Rating Scale ◽

Weight Bearing ◽

Rehabilitation Program ◽

Triangular Fibrocartilage Complex ◽

Effect Sizes ◽

Pronator Quadratus ◽

Triangular Fibrocartilage ◽

Wrist Function

Introduction Triangular fibrocartilage complex (TFCC) injuries are associated with distal radioulnar joint (DRUJ) instability and impaired wrist proprioception. Sensorimotor training of extensor carpi ulnaris (ECU) and pronator quadratus (PQ) can enhance DRUJ stability. With limited evidence on effectiveness of TFCC sensorimotor rehabilitation, this study aimed to evaluate the effects and feasibility of a novel wrist sensorimotor rehabilitation program (WSRP) for TFCC injuries. Methods Patients diagnosed with TFCC injuries were recruited from May 2018 to January 2020 at an outpatient hand clinic in Singapore General Hospital. There are four stages in WSRP: (1) pain control, (2) muscle re-education and joint awareness, (3) neuromuscular rehabilitation, and (4) movement normalization and function. WSRP also incorporated dart throwing motion and proprioceptive neuromuscular facilitation. Outcome measures included grip strength measured with grip dynamometer, numerical pain rating scale, joint position sense (JPS) measurement, weight bearing measured with the ‘push-off’ test, and wrist function reported on the Patient Rated Wrist Hand Evaluation. Results Ten patients completed the WSRP. Mean changes were compared with minimal clinically important differences (MCID) for outcomes. All patients achieved MCID on pain, 70% of patients achieved MCID on grip strength, weight bearing and wrist function. Paired t-tests and Cohen’s D for outcome measures were calculated. There were large effect sizes of 2.47, 1.35, and 2.81 for function, grip strength and pain respectively, and moderate effect sizes of 0.72 and 0.39 for axial loading and JPS respectively. Discussion WSRP presents a potential treatment approach in TFCC rehabilitation. There is a need for future prospective clinical trials with control groups.

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