Arthroscopic Ligament-specific Repair for Triangular Fibrocartilage Complex Foveal Avulsion: A Novel Technique

2020 ◽  
Vol 24 (4) ◽  
pp. 175-181
Author(s):  
Bo Liu ◽  
Margareta Arianni
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Novel Technique ◽  
Triangular Fibrocartilage

scholarly journals The Suction Test: A Novel Technique to Identify and Verify Successful Repair of Peripheral Triangular Fibrocartilage Complex Tears

2017 ◽  
Vol 06 (04) ◽  
pp. 334-335 ◽  
Author(s):  
Ryan Greene ◽  
Sanjeev Kakar
Keyword(s):  
Literature Review ◽  
Clinical Relevance ◽  
Triangular Fibrocartilage Complex ◽  
Case Description ◽  
Arthroscopic Technique ◽  
Novel Technique ◽  
Triangular Fibrocartilage ◽  
The Subject ◽  
Successful Repair

Background The diagnoses of peripheral triangular fibrocartilage complex (TFCC) tears continue to be the subject of numerous investigations. Case Description We describe a novel arthroscopic technique that may be used as an adjunct with other arthroscopic maneuvers to diagnose and confirm repair of peripheral sided TFCC injuries. Literature Review The hook and trampoline tests are intraoperative techniques to diagnose TFCC tears. Clinical Relevance The suction test provides a means to detect peripheral tears and to confirm restoration of its tension post repair.

Arthroscopic Trans-osseous Suture of Peripheral Triangular Fibrocartilage Complex Tear

2016 ◽  
Vol 21 (03) ◽  
pp. 300-306 ◽  
Author(s):  
Midum Jegal ◽  
Kang Heo ◽  
Jong Pil Kim
Keyword(s):  
Clinical Outcome ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Radioulnar Joint ◽  
Novel Technique ◽  
Repair Technique ◽  
Deep Layers ◽  
Successful Clinical Outcome ◽  
Triangular Fibrocartilage ◽  
Increasing Knowledge

The importance of foveal repair of the triangular fibrocartilage complex (TFCC) on stability of the distal radioulnar joint (DRUJ) has been emphasized with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Although both open and arthroscopic techniques have been described for improving DRUJ stability, there has been a marked evolution of arthroscopic TFCC repair technique with successful clinical outcome. Recently, an arthroscopic trans-osseous technique has been described to repair foveal tears of the TFCC. The advantage of the technique is that it allows for anatomical repair of both the superficial and deep layers. This article describes the details of this novel technique.

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.

scholarly journals The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

2021 ◽  
Author(s):  
Anne-Sophie van der Post ◽  
Sjoerd Jens ◽  
Frank F. Smithuis ◽  
Miryam C. Obdeijn ◽  
Roelof-Jan Oostra ◽  
...  
Keyword(s):  
Signal Intensity ◽  
Sagittal Plane ◽  
Articular Surface ◽  
Triangular Fibrocartilage Complex ◽  
Ulnar Variance ◽  
Observer Agreement ◽  
Mri Findings ◽  
Mri Features ◽  
Triangular Fibrocartilage ◽  
The Individual

Abstract Objective The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. Materials and methods Prospectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI). Results The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. Conclusion MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

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