Commentary on “Biomechanical Analysis of All-Inside, Arthroscopic Suture Repair Versus Extensor Retinaculum Capsulorrhaphy for Triangular Fibrocartilage Complex Tears With Instability”

2016 ◽  
Vol 41 (3) ◽  
pp. 394
Author(s):  
Virak Tan
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Biomechanical Analysis ◽  
Suture Repair ◽  
Extensor Retinaculum ◽  
Triangular Fibrocartilage

Biomechanical Analysis of Reconstruction Methods for Peripheral Triangular Fibrocartilage Complex Tears

2015 ◽  
Vol 40 (9) ◽  
pp. e44
Author(s):  
Amar Arun Patel ◽  
Ali Alhandi ◽  
Ted Milne ◽  
Anna Makowski ◽  
Loren Latta ◽  
...  
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Biomechanical Analysis ◽  
Reconstruction Methods ◽  
Triangular Fibrocartilage

Chronic Posttraumatic Instability of the Distal Radioulnar Joint: Foveal Reattachment of the Triangular Fibrocartilage Complex With Dorsal Capsuloplasty and Extensor Retinaculum Imbrications

Hand ◽  
2020 ◽  
pp. 155894472091256
Author(s):  
Bernardo C. Neto ◽  
Junot H. S. Neto
Keyword(s):  
Medical Records ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Extensor Retinaculum ◽  
Forearm Rotation ◽  
Radioulnar Joint ◽  
Posttraumatic Instability ◽  
Triangular Fibrocartilage ◽  
Dash Questionnaire

Background: The purpose of this article is to describe the surgical technique used by the authors and the outcome in the treatment of chronic posttraumatic instability of the distal radioulnar joint (DRUJ). Methods: A retrospective study was conducted analyzing the medical records of 11 patients with chronic posttraumatic instability of the DRUJ, treated by a foveal reattachment of the triangular fibrocartilage complex with dorsal capsular and extensor retinaculum imbrications between 2016 and 2017, with a follow-up evaluation of 1 year. Results: All patients reported pain relief and the absence of instability, returning to normal activities in 3 to 6 months. Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire ranged from 2 to 25, resulting in a mean score of 9.5. Forearm rotation averaged 89° of pronation and 85° of supination. Conclusion: Foveal reattachment of the triangular fibrocartilage complex with dorsal capsular and extensor retinaculum imbrications is an effective surgical procedure for the treatment of DRUJ chronic posttraumatic instability.

scholarly journals Biomechanical Analysis of Capsular Repair Versus Arthrex TFCC Ulnar Tunnel Repair for Triangular Fibrocartilage Complex Tears

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 547-553 ◽  
Author(s):  
Jayson C. Johnson ◽  
Ferris M. Pfeiffer ◽  
Jill E. Jouret ◽  
David M. Brogan
Keyword(s):  
Statistical Significance ◽  
Triangular Fibrocartilage Complex ◽  
Optical Tracking ◽  
Biomechanical Analysis ◽  
Wrist Arthroscopy ◽  
Intact Specimen ◽  
Capsular Repair ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Ulnar Tunnel

Background: This study compares the effectiveness of a peripheral capsular repair with a knotless arthroscopic transosseous ulnar tunnel repair (TR) in restoring distal radioulnar joint (DRUJ) stability and stiffness in the setting of a massive triangular fibrocartilage complex (TFCC) tear. Methods: Eight matched pairs of fresh-frozen cadaveric forearms were tested. Each forearm was tested in supination and pronation using 3-dimensional (3D) optical tracking devices prior to any intervention. Each specimen then underwent a diagnostic wrist arthroscopy and sectioning of the TFCC’s deep and superficial fibers. All specimens were then retested to assess instability secondary to the tear. The TFCC was repaired with either a peripheral capsular repair (CR) using three 2-0 polydioxanone sutures or a transosseous ulnar TR using a 2-0 FiberWire, and then retested (statistical significance; P < .05). Results: After TFCC arthroscopic sectioning, all specimens were unstable with a significant increase in translation and a significant decrease in stiffness. TFCC repair with TR resulted in displacement and stiffness similar to the native tissue. CR specimens were found to have significantly greater displacement and significantly decreased stiffness compared with the intact state. Conclusions: Arthroscopic sectioning of the TFCC resulted in DRUJ instability, as measured by stiffness and ulnar translation. TR effectively restored DRUJ stability and demonstrated no significant difference in postoperative stiffness or maximal displacement when compared with the intact specimen in pronation and supination. This study provides biomechanical evidence that an arthroscopic ulnar tunnel technique can restore stability to the DRUJ after a massive TFCC tear.

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

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

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

Hand Therapy ◽  
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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