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Arthroscopic-Assisted TFCC Reconstruction with Tendon Graft for Chronic DRUJ Instability

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Arthroscopy and Endoscopy of the Elbow, Wrist and Hand

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Abstract

The palmar and dorsal radioulnar ligaments (RULs) are the most important primary stabilizers of DRUJ, and damage to either or both of these ligaments generates pain and instability during forearm rotation. Biomechanical studies show that anatomical reconstruction of RULs is the ultimate solution for chronic painful DRUJ instability. Arthroscopic-assisted reconstruction has advantages of minimizing soft tissue disruption, more accurate placement of bone tunnels, and preservation of motion and function. Radiocarpal joint arthroscopy is conducted to evaluate and debride TFCC lesion and associated synovitis. A dorsal skin incision extending from the 4–5 portal is made to retract extensor tendon. A volar skin incision is made for harvesting palmaris longus tendon graft. Drill hole of 2.4 mm using a cannulated drill is made dorsal to volar over margin of sigmoid notch under image intensifier, simulating the radial insertions of RULs. A third incision is made at subcutaneous border of distal ulna and a drill hole of 2.9–3.2 mm created at fovea of ulnar head, the isometric origin of TFCC under arthroscopic and fluoroscopic surveillance. Tendon graft is passed through the bone tunnels and tied around a trans-osseous tunnel over the distal ulna with forearm in neutral position. Early midrange forearm rotation could be started from the fourth week onward postoperatively. Twenty-eight patients were followed up for 62 months (range 3–138) with improvement in grip strength, flexion-extension range, Mayo wrist score, and VAS pain score. The mean pronosupination range improved from 84.6% to 91.2% of the normal side compared with preoperative range. Radiographic assessment revealed no progressive enlargement of the tunnels or arthrosis of the DRUJ. We conclude that arthroscopic-assisted anatomical reconstruction of TFCC using tendon graft is a preferred treatment option in symptomatic peripheral destabilizing TFCC lesions not amendable for repair either due to its chronicity or presence of sizable defect. The method preserves better pronosupination motion of the forearm compared to open surgery.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China

    Michael Chu-kay Mak, Wing-lim Tse & Pak-cheong Ho

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  1. Michael Chu-kay Mak
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  2. Wing-lim Tse
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  3. Pak-cheong Ho
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Correspondence to Pak-cheong Ho .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, Sir HN Reliance Foundation Hospital and Research Center, Mumbai, India

    Deepak N. Bhatia

  2. Department of Orthopaedic Surgery, Flinders University, Adelaide, SA, Australia

    Gregory I. Bain

  3. Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Gary G. Poehling

  4. Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Benjamin R. Graves

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Mak, M.Ck., Tse, Wl., Ho, Pc. (2022). Arthroscopic-Assisted TFCC Reconstruction with Tendon Graft for Chronic DRUJ Instability. In: Bhatia, D.N., Bain, G.I., Poehling, G.G., Graves, B.R. (eds) Arthroscopy and Endoscopy of the Elbow, Wrist and Hand. Springer, Cham. https://doi.org/10.1007/978-3-030-79423-1_92

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  • DOI: https://doi.org/10.1007/978-3-030-79423-1_92

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-79422-4

  • Online ISBN: 978-3-030-79423-1

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