Clinical Outcomes of Open Surgical Repair for Triangular Fibrocartilage Complex Foveal Detachment

Abstract Objective This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears. Methods A systematic review of MEDLINE and EMBASE was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The focus was on traumatic Palmer 1B ulna-sided tears. Twenty-seven studies were included, including three comparative cohort studies. Results There was improvement in all functional outcome measures after repair of TFCC tears. The outcomes following peripheral and foveal repairs were good overall: Mayo Modified Wrist Evaluation (MMWE) score of 80.1 and 85.1, Disabilities of the Arm, Shoulder and Hand (DASH) score of 15.7 and 15.8, grip strength of 80.3 and 92.7% (of the nonoperated hand), and pain intensity score of 2.1 and 1.7, respectively. For peripheral tears, transosseous suture technique achieved better outcomes compared with capsular sutures in terms of grip strength, pain, Patient-Rated Wrist Evaluation (PRWE), and DASH scores (grip 85.8 vs. 77.7%; pain 1.5 vs. 2.2; PRWE 11.6 vs. 15.8; DASH 14.4 vs. 16.1). For foveal tears, transosseous sutures achieved overall better functional outcomes compared with suture anchors (MMWE 85.4 vs. 84.9, DASH 10.9 vs. 20.6, pain score 1.3 vs. 2.1), but did report slightly lower grip strength than the group with suture anchors (90.2 vs. 96.2%). Arthroscopic techniques achieved overall better outcomes compared with open repair technique. Conclusion Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. Level of Evidence This is a Level IV therapeutic study.

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Repair of Foveal Detachment of the Triangular Fibrocartilage Complex: Open and Arthroscopic Transosseous Techniques

Hand Clinics ◽

10.1016/j.hcl.2011.05.002 ◽

2011 ◽

Vol 27 (3) ◽

pp. 281-290 ◽

Cited By ~ 63

Author(s):

Toshiyasu Nakamura ◽

Kazuki Sato ◽

Masato Okazaki ◽

Yoshiaki Toyama ◽

Hiroyasu Ikegami

Keyword(s):

Triangular Fibrocartilage Complex ◽

Foveal Detachment ◽

Triangular Fibrocartilage

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Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

Archives of Hand and Microsurgery ◽

10.12790/ahm.20.0026 ◽

2020 ◽

Vol 25 (3) ◽

pp. 167-174

Author(s):

Hyunseok Seo ◽

Joo-Yup Lee

Keyword(s):

Clinical Outcomes ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Radioulnar Joint ◽

Ulnar Shortening Osteotomy ◽

Ulnar Impaction ◽

Shortening Osteotomy ◽

Triangular Fibrocartilage ◽

Ulnar Impaction Syndrome ◽

Important Structure

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

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Variation in Repair of the Triangular Fibrocartilage Complex

Journal of Wrist Surgery ◽

10.1055/s-0038-1625953 ◽

2018 ◽

Vol 07 (03) ◽

pp. 243-246

Author(s):

Thomas Kootstra ◽

Wouter van Leeuwen ◽

Neal Chen ◽

David Ring

Keyword(s):

Surgical Repair ◽

Decision Aids ◽

Treatment Options ◽

Triangular Fibrocartilage Complex ◽

Wrist Pain ◽

Mri Scan ◽

Level Of Evidence ◽

Factors Associated ◽

Triangular Fibrocartilage ◽

Signal Changes

Background There is controversy regarding the value of repair of the triangular fibrocartilage complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal radius fracture uncommonly benefits from repair, the role of repair in other settings is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon. Purpose The purpose of this study is to determine the rate of TFCC repair in patients who had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided wrist pain, and that showed signal changes in the TFCC. We tested the primary null hypothesis that there are no demographic or surgeon factors associated with repair of the TFCC. Patients and Methods Three hundred and ninety-four patients with ulnar-sided wrist pain and an MRI scan showing changes in the TFCC were included in this retrospective study. No patients had instability of the distal radioulnar joint (DRUJ) recorded in the medical record. Surgical repair of TFCC tears was used as the primary outcome during statistical analysis to identify factors associated with repair. Results Out of 394 (6%), 25 patients underwent TFCC repair. We found that 10% of the treating surgeons (4 out of 41) performed 80% of the procedures (20 out of 25). Patients who discerned a trauma prior to their symptoms and patients whose MRI showed signal changes primarily in the ulnar portion of the TFCC were more likely to have surgical repair. Conclusion We found that the rate of TFCC repair varies substantially from surgeon-to-surgeon. The observation that repair is more likely to happen when patients perceive themselves as injured suggests that perception of injury affects how patients and surgeons consider treatment options. To help avoid surgeries based on surgeon bias or patient misperception, we suggest studying the effect of tools that provide simple, balanced, dispassionate, and empowering information (e.g., decision aids) that can limit surgeon-to-surgeon variation. Level of Evidence Level IV.

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