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

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.

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 ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Ultrasound Assessment ◽

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

THE BEAUTY OF STABILITY: DISTAL RADIOULNAR JOINT STABILITY IN ARTHROSCOPIC TRIANGULAR FIBROCARTILAGE COMPLEX REPAIR

Hand Surgery ◽

10.1142/s0218810413500044 ◽

2013 ◽

Vol 18 (01) ◽

pp. 21-26 ◽

Cited By ~ 7

Author(s):

Chris Tang ◽

Boris Fung ◽

Rebecca Chan ◽

Margaret Fok

Keyword(s):

Stress Test ◽

Distal Radioulnar Joint ◽

Small Sample ◽

Radioulnar Joint ◽

Transosseous Suture ◽

Sigmoid Notch ◽

Druj Instability ◽

The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. The average post-operative follow-up period was 8.2 months; 66.7% of the patients with TFCC tear in sigmoid notch had clinical DRUJ instability, while only 50% of tear in fovea and 16.7% of tear in base of ulnar styloid had clinical DRUJ instability. Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.

Arthroscopic transosseous foveal footprint repair of the triangular fibrocartilage complex

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211065874 ◽

2022 ◽

pp. 175319342110658

Author(s):

Chen-Yuan Yang ◽

Wei-Jen Chen

Keyword(s):

Distal Radioulnar Joint ◽

Bone Tunnel ◽

Functional Score ◽

Level Of Evidence ◽

Radioulnar Joint ◽

Repair Technique ◽

Significant Difference ◽

Foveal disruption of the triangular fibrocartilage complex contributes to the instability of distal radioulnar joint. We have developed an arthroscopic transosseous foveal footprint repair technique, which maximizes the contact between the disrupted triangular fibrocartilage complex and its foveal footprint for better healing by using four sutures in a divergent configuration through a 1.6-mm bone tunnel. Twelve patients with triangular fibrocartilage complex foveal injuries who had undergone this repair technique were reviewed with a mean follow-up of 53 months. All patients achieved significant improvement in the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score. All patients had stable distal radioulnar joints with comparable ranges of motion and grip strengths between the operated and contralateral wrists. There was no significant difference in functional score in those who were treated more than 6 months after injury. Level of evidence: IV

FUNCTIONAL RESULTS POST-TRIANGULAR FIBROCARTILAGE COMPLEX RECONSTRUCTION WITH EXTENSOR CARPI ULNARIS WITH OR WITHOUT ULNAR SHORTENING IN CHRONIC DISTAL RADIOULNAR JOINT INSTABILITY

Hand Surgery ◽

10.1142/s0218810405002759 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 169-176 ◽

Cited By ~ 15

Author(s):

Jui-Tien Shih ◽

Hung-Maan Lee

Keyword(s):

Functional Results ◽

Distal Radioulnar Joint ◽

Radioulnar Joint ◽

Extensor Carpi Ulnaris ◽

Druj Instability ◽

Sport Activities ◽

Triangular Fibrocartilage ◽

Post Traumatic

From September 1996 to September 2001, 37 adult patients were diagnosed with chronic triangular fibrocartilage complex (TFCC) tears with distal radioulnar joint (DRUJ) instability in our clinic. They had all received the procedure of TFCC reconstruction with partial extensor carpi ulnaris (ECU) combined with or without ulnar shortening. There were 36 males and one female in the study with a mean age of 22.4 years. The follow-up period ranged from 25 to 48 months with a mean of 36.2 months. All patients received the rehabilitation programme and were re-examined at our outpatient department. The results were graded according to the Mayo Modified Wrist Score. Eleven of the 37 patients rated their wrists "excellent", 22 rated "good", and four rated "fair". Overall, a total of 33 patients (89%) rated satisfactorily and returned to work or sport activities. Therefore, TFCC reconstruction with partial ECU tendon combined with or without ulnar shortening procedure is an effective method for post-traumatic chronic TFCC tears with DRUJ instability suggested by this study.

Review of Palmer and Werner (1981) on the triangular fibrocartilage complex of the wrist anatomy and function

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2017-000135 ◽

2017 ◽

Vol 2 (6) ◽

pp. 350-354

Author(s):

Teun Teunis ◽

David Ring

Keyword(s):

Surgical Treatment ◽

Soft Tissue ◽

Distal Radioulnar Joint ◽

Original Publication ◽

Radioulnar Joint ◽

Triangular Fibrocartilage ◽

Wrist Anatomy ◽

And Function

This classic discusses the original publication by Palmer and Werner (1981) on the anatomy and function of a set of soft tissue stabilising the distal radioulnar joint. They labelled this confluent structure the triangular fibrocartilage complex (TFCC) of the wrist, and concluded that abnormalities were typically degenerative and usually asymptomatic. Eight years later Dr Palmer published a follow-up taking a different perspective. In this article he differentiated between traumatic and degenerative TFCC lesions and outlined surgical treatment for each type. The debate about the diagnosis, interpretation and treatment of TFCC abnormalities today is captured by the contrast between both articles.

Arthroscopic Capsular Repair for Triangular Fibrocartilage Complex Tears

Journal of Wrist Surgery ◽

10.1055/s-0040-1721140 ◽

2020 ◽

Author(s):

Takehiko Takagi ◽

Toshiyasu Nakamura ◽

Masatoshi Fukuoka

Keyword(s):

Evaluation System ◽

Clinical Results ◽

Distal Radioulnar Joint ◽

Forearm Rotation ◽

Radioulnar Joint ◽

Capsular Repair ◽

Arthroscopic Findings ◽

Class 1 ◽

Abstract Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique. Description of Technique We inserted a 21-gauge needle with 4–0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4–0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule. Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively. Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less. Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.

Patients With Triangular Fibrocartilage Complex Injuries and Distal Radioulnar Joint Instability Gain Improved Forearm Peak Pronation and Supination Torque After Reinsertion

Hand ◽

10.1177/1558944718793198 ◽

2018 ◽

Vol 15 (2) ◽

pp. 281-286

Author(s):

Jonny K. Andersson ◽

Elisabet M. Hagert ◽

Jan Fridén

Keyword(s):

Case Series ◽

Peak Torque ◽

Distal Radioulnar Joint ◽

Retrospective Case ◽

Radioulnar Joint ◽

Druj Instability ◽

Torque Measurements ◽

Background: Forearm peak pronation and supination torque measurements are reduced up to 30% in patients with triangular fibrocartilage complex (TFCC) 1B injuries with concomitant distal radioulnar joint (DRUJ) instability. The aim of our study was to evaluate whether patients with TFCC 1B injuries, with concomitant DRUJ instability, improve in forearm peak pronation and supination torque following TFCC reinsertion surgery where postoperative DRUJ stability was achieved. Methods: We report a retrospective case series with short-term follow-up (20 months) of the postoperative forearm peak torque in pronation and supination in 11 patients (9 women/2 men, average age at surgery 32 years) operated on by TFCC reinsertion. Two of the initial 13 patients were later on reoperated due to recurring DRUJ instability and were therefore excluded in this follow-up study. Nine were treated by arthroscopic TFCC reinsertion and 2 by open technique. The forearm peak pronation and supination torque were measured pre- and postoperatively and compared with the uninjured side. Results: On average, a 16% improvement of the forearm peak torque was achieved in the injured wrist, as well as clinically assessed DRUJ stability. Functional postoperative improvement was noted in all patients, with reduced pain, good satisfaction, and acceptance of the surgery and the final result. Conclusion: We conclude that patients with TFCC injuries and DRUJ instability gain improved forearm peak pronation and supination torque after reinsertion. We also conclude that forearm peak pronation and supination torque is a valuable tool in the preoperative diagnostics of TFCC injuries with DRUJ instability as well as in the postoperative follow-up.

TREATMENTS OF OSTEOARTHRITIS OF THE DISTAL RADIOULNAR JOINT: LONG-TERM RESULTS OF THREE PROCEDURES

Hand Surgery ◽

10.1142/s0218810405002942 ◽

2005 ◽

Vol 10 (02n03) ◽

pp. 243-248 ◽

Cited By ~ 38

Author(s):

Akio Minami ◽

Norimasa Iwasaki ◽

Jun-ichi Ishikawa ◽

Naoki Suenaga ◽

Kazunori Yasuda ◽

...

Keyword(s):

Grip Strength ◽

Statistical Significance ◽

Distal Radioulnar Joint ◽

Ulnar Variance ◽

Long Term Results ◽

Interposition Arthroplasty ◽

Secondary Osteoarthritis ◽

Radioulnar Joint ◽

Sixty-one wrists in 61 patients with osteoarthritis of the distal radioulnar joint treated by three consecutive procedures (20 Darrach, 25 Sauvé-Kapandji and 16 hemiresection-interposition arthroplastic procedures) were retrospectively evaluated. We preferred to perform Darrach's procedure in even the early stages of osteoarthritis of the distal radioulnar joint prior to introduction of Sauvé-Kapandji and hemirestion-interposition arthroplastic procedures. Subsequently the hemirestion-interposition arthroplasty was indicated when the triangular fibrocartilage cartilage was intact or could be reconstructed and the Sauvé-Kapandji when the triangular fibrocartilage complex could not be reconstructed or there was positive ulnar variance of more than 5 mm even though the triangular fibrocartilage complex was functional. Patient's age at operation averaged 59.8 years. There were 36 men and 25 women. There were 38 primary and 23 secondary osteoarthritis cases. Post-operative pain, range of motion, grip strength, return to work status; and radiographic results were evaluated. At the five- to 14-year (average, ten years) follow-up evaluation, relief of pain from Darrach procedure was inferior to the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty although this was not statistically significant. After both the Sauvé-Kapandji procedure and hemiresection-inteposition arthroplasty, post-operative improvements in flexion and extension of the wrist had statistical significance. Post-operative improvements in pronation and supination of the forearm showed statistical significances after all procedures. Improvements of post-operative grip strength and return to an original job in the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty were statistically superior to those with a Darrach's procedure. There were many post-operative complications following the Darrach's procedure. Darrach's procedure is better indicated for severe osteoarthritic changes of the distal radioulnar joint in elderly patients. We believe the operative indications between the Sauvé-Kapandji procedure and hemiresection-interposition arthroplasty are best determined prior to surgery by the existence and status of the triangular fibrocartilage complex and the amount of the positive ulnar variance.

Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures

The Journal Of Hand Surgery ◽

10.1053/jhsu.2000.6467 ◽

2000 ◽

Vol 25 (3) ◽

pp. 464-468 ◽

Cited By ~ 173

Author(s):

Tommy Lindau ◽

Catarina Adlercreutz ◽

Per Aspenberg

Keyword(s):

Joint Instability ◽

Distal Radioulnar Joint ◽

Distal Radial Fractures ◽

Radioulnar Joint ◽

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 ◽

Wrist Arthroscopy ◽

Level Of Evidence ◽

Independent Observer ◽

Radioulnar Joint ◽

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.