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Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear

Abstract

Purpose

Arthroscopic repair of a peripheral triangular fibrocartilage complex (TFCC) tear is a promising, minimally invasive surgical technique, especially in patients with symptomatic distal radioulnar joint (DRUJ) instability. The purpose of this study was to evaluate the clinical result of arthroscopic one-tunnel transosseous foveal repair for peripheral TFCC tears.

Methods

Sixteen patients who underwent TFCC foveal repair were retrospectively evaluated. The mean follow-up period was 31.1 months. The torn TFCC of all patients was repaired with the arthroscopic one-tunnel transosseous foveal repair technique. Postoperative outcomes were evaluated using the visual analogue scale (VAS) for pain, wrist range of motion, grip strength, Mayo wrist score, Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH) score, and postoperative complications.

Results

On arthroscopic examination, all 16 patients showed Palmer 1B type peripheral TFCC tears with foveal disruption. Among them, 13 patients had a proximal component TFCC tear (Atzei class 3) and 3 patients had a complete TFCC tear (Atzei class 2). At the final follow-up, the mean range of the pronation–supination arc (P = 0.03) and grip strength (P = 0.001) was significantly increased. Twelve patients had normal stability of the DRUJ and six patients showed mild laxity compared with the contralateral side. The mean VAS for pain perception decreased from 3.7 to 0.8 (P = 0.001). The modified Mayo wrist (P = 0.001) and Quick DASH (P = 0.001) scores showed significant functional improvement. No surgery-related complications occurred.

Conclusions

The present study shows that arthroscopic one-tunnel transosseous repair is a good treatment strategy for TFCC foveal tears in terms of reliable pain relief, functional improvement, and re-establishment of DRUJ stability.

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References

  1. 1.

    Kirchberger MC, Unglaub F, Muhldorfer-Fodor M, Pillukat T, Hahn P, Muller LP, Spies CK (2015) Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 135(3):427–437. https://doi.org/10.1007/s00402-015-2153-6

    Article  PubMed  Google Scholar 

  2. 2.

    Iwasaki N, Minami A (2009) Arthroscopically assisted reattachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head. J Hand Surg Am 34(7):1323–1326. https://doi.org/10.1016/j.jhsa.2009.02.026

    Article  PubMed  Google Scholar 

  3. 3.

    Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 6(2):153–162

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Atzei A (2009) New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur 34(5):582–591. https://doi.org/10.1177/1753193409100120

    CAS  Article  Google Scholar 

  5. 5.

    Nakamura T, Makita A (2000) The proximal ligamentous component of the triangular fibrocartilage complex. J Hand Surg Br 25(5):479–486

    CAS  PubMed  Google Scholar 

  6. 6.

    Moritomo H, Masatomi T, Murase T, Miyake J, Okada K, Yoshikawa H (2010) Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg Am 35(12):1955–1963. https://doi.org/10.1016/j.jhsa.2010.07.031

    Article  PubMed  Google Scholar 

  7. 7.

    Schmelzer-Schmied N (2016) Arthroscopic refixation of TFCC by bone screw anchor. Oper Orthop Traumatol 28(4):251–262. https://doi.org/10.1007/s00064-016-0455-7

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Pillukat T, Fuhrmann RA, Windolf J, van Schoonhoven J (2016) Arthroscopically assisted transcapsular refixation of the triangular fibrocartilage complex of the wrist. Oper Orthop Traumatol 28(4):233–250. https://doi.org/10.1007/s00064-016-0466-4

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H (2011) Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 27(3):281–290. https://doi.org/10.1016/j.hcl.2011.05.002

    Article  PubMed  Google Scholar 

  10. 10.

    Spies CK, Prommersberger KJ, Langer M, Muller LP, Hahn P, Unglaub F (2015) Instability of the distal radioulnar joint: treatment options for ulnar lesions of the triangular fibrocartilage complex. Unfallchirurg 118(8):701–717. https://doi.org/10.1007/s00113-015-0044-5

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Atzei A, Luchetti R (2011) Foveal TFCC tear classification and treatment. Hand Clin 27(3):263–272. https://doi.org/10.1016/j.hcl.2011.05.014

    Article  PubMed  Google Scholar 

  12. 12.

    Schmauss D, Pohlmann S, Lohmeyer JA, Germann G, Bickert B, Megerle K (2016) Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Arch Orthop Trauma Surg 136(6):873–880. https://doi.org/10.1007/s00402-016-2441-9

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Low S, Erne H, Schutz A, Eingartner C, Spies CK (2015) The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies. Arch Orthop Trauma Surg 135(12):1771–1777. https://doi.org/10.1007/s00402-015-2339-y

    Article  PubMed  Google Scholar 

  14. 14.

    Springorum HR, Winkler S, Maderbacher G, Gotz J, Heers G, Grifka J, Preissler P (2015) Wrist arthroscopy: challenging procedure of modern hand surgery. Orthopade 44(1):89–102. https://doi.org/10.1007/s00132-014-3059-7

    Article  PubMed  Google Scholar 

  15. 15.

    Hagert E, Lalonde DH (2012) Wide-awake wrist arthroscopy and open TFCC repair. J Wrist Surg 1(1):55–60. https://doi.org/10.1055/s-0032-1312045

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Desai MJ, Hutton WC, Jarrett CD (2013) Arthroscopic repair of triangular fibrocartilage tears: a biomechanical comparison of a knotless suture anchor and the traditional outside-in repairs. J Hand Surg Am 38(11):2193–2197. https://doi.org/10.1016/j.jhsa.2013.08.097

    Article  PubMed  Google Scholar 

  17. 17.

    Tunnerhoff HG, Langer M (2014) Arthroscopic repair for ulnar-sided tears of the TFCC. Handchir Mikrochir Plast Chir 46(5):286–294. https://doi.org/10.1055/s-0034-1385937

    Article  PubMed  Google Scholar 

  18. 18.

    Tay SC, Tomita K, Berger RA (2007) The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 32(4):438–444. https://doi.org/10.1016/j.jhsa.2007.01.022

    Article  PubMed  Google Scholar 

  19. 19.

    Tang C, Fung B, Chan R, Fok M (2013) The beauty of stability: distal radioulnar joint stability in arthroscopic triangular fibrocartilage complex repair. Hand Surg 18(1):21–26. https://doi.org/10.1142/S0218810413500044

    Article  PubMed  Google Scholar 

  20. 20.

    Yoshioka H, Burns JE (2012) Magnetic resonance imaging of triangular fibrocartilage. J Magn Reson Imaging 35(4):764–778. https://doi.org/10.1002/jmri.22840

    Article  PubMed  Google Scholar 

  21. 21.

    Bain GI, McGuire D, Lee YC, Eng K, Zumstein M (2014) Anatomic foveal reconstruction of the triangular fibrocartilage complex with a tendon graft. Tech Hand Up Extrem Surg 18(2):92–97. https://doi.org/10.1097/BTH.0000000000000044

    Article  PubMed  Google Scholar 

  22. 22.

    Iwasaki N, Nishida K, Motomiya M, Funakoshi T, Minami A (2011) Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study. Arthroscopy 27(10):1371–1378. https://doi.org/10.1016/j.arthro.2011.05.020

    Article  PubMed  Google Scholar 

  23. 23.

    Wolf MB, Kroeber MW, Reiter A, Thomas SB, Hahn P, Horch RE, Unglaub F (2010) Ulnar shortening after TFCC suture repair of Palmer type 1B lesions. Arch Orthop Trauma Surg 130(3):301–306. https://doi.org/10.1007/s00402-008-0719-2

    Article  PubMed  Google Scholar 

  24. 24.

    Chou KH, Sarris IK, Sotereanos DG (2003) Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears. J Hand Surg Br 28(6):546–550

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Nakamura T, Nakao Y, Ikegami H, Sato K, Takayama S (2004) Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg 8(2):116–123. https://doi.org/10.1097/01.bth.0000126573.05697.29

    Article  PubMed  Google Scholar 

  26. 26.

    Shinohara T, Tatebe M, Okui N, Yamamoto M, Kurimoto S, Hirata H (2013) Arthroscopically assisted repair of triangular fibrocartilage complex foveal tears. J Hand Surg Am 38(2):271–277. https://doi.org/10.1016/j.jhsa.2012.11.008

    Article  PubMed  Google Scholar 

  27. 27.

    Woo SJ, Jegal M, Park MJ (2016) Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury. Indian J Orthop 50(3):263–268. https://doi.org/10.4103/0019-5413.181790

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Ruch DS, Anderson SR, Ritter MR (2003) Biomechanical comparison of transosseous and capsular repair of peripheral triangular fibrocartilage tears. Arthroscopy 19(4):391–396. https://doi.org/10.1053/jars.2003.50137

    Article  PubMed  Google Scholar 

  29. 29.

    Spies CK, Niehoff A, Unglaub F, Muller LP, Langer MF, Neiss WF, Oppermann J (2016) Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study. Int Orthop 40(2):315–321. https://doi.org/10.1007/s00264-015-2986-1

    Article  PubMed  Google Scholar 

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Correspondence to Jong Woong Park.

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The authors did not receive any outside funding or grants in support of their research for or preparation of this work.

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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ji Hun Park and Dongmin Kim equally contributed in this article.

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Cite this article

Park, J.H., Kim, D. & Park, J.W. Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear. Arch Orthop Trauma Surg 138, 131–138 (2018). https://doi.org/10.1007/s00402-017-2835-3

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Keywords

  • TFCC
  • Foveal tear
  • Wrist arthroscopy
  • Transosseous repair