Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex
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Injuries of the triangular fibrocartilage complex (TFCC) are of high clinical relevance; however, the clinical evidence for treatment is poor and long-term results are rarely published. The purpose of this study was to evaluate the clinical outcome of symptomatic central traumatic lesions of the TFCC (Palmer 1A) following arthroscopic debridement.
Materials and methods
Between 2007 and 2013, 87 patients were arthroscopically diagnosed with Palmer 1A lesion and accordingly treated with debridement. Follow-up was available for 43 patients. Activities of daily living (ADLs) were measured with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Pain perception was evaluated with visual analogue scale (VAS 0–10). Grip strength and wrist motion were assessed with conventional techniques using a Jamar dynamometer and a goniometer. Patient satisfaction was assessed using a questionnaire at follow-up.
Mean follow-up was 42.5 months (range 5–70). The mean age of the patients (22 male and 21 female) at time of surgery was 41 ± 15.9 years. No major complication occurred during surgery and follow-up. The DASH score (preoperatively 49.8 ± 19.3 vs. postoperatively 14.1 ± 17.9, p < 0.05) and pain perception (VAS: preoperatively 7.2 ± 2.0 vs. postoperatively 1.4 ± 1.6, p < 0.05) improved significantly. Grip strength was satisfactory after surgery (19.6 ± 13.1). Ulnar deviation improved significantly from 29.3 ± 10.4° to 35.6 ± 8.3° (p < 0.05) and wrist flexion improved from 53.8 ± 18.9° to 67.4 ± 12.9° (p < 0.05). Wrist extension, radial deviation, pronation and supination did not change significantly after surgery. Improved symptoms were reported by 41/43 (95.3%) patients and 40/43 (93%) patients would have had the same procedure again knowing the final outcome. Six of 43 patients (15%) had an ulnar plus variance. None of these needed ulnar shortening.
Central traumatic TFCC lesions can safely be treated by arthroscopic debridement. We showed a sustained pain relief with significantly improved quality of life (DASH score) and wrist motion at follow-up. This resulted in a high patient satisfaction and acceptance of the procedure.
Type of study/level of evidence
Therapeutic, level IV.
KeywordsTFCC Wrist Arthroscopy Central tear of discus
We thank our librarian Claudia Diemann-Paeth for helping with the literature research.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
The institutional ethics committee approved the study design.
- 9.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 CrossRefPubMedGoogle Scholar
- 14.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. Archiv Orthop Trauma Surg 136(6):873–880. https://doi.org/10.1007/s00402-016-2441-9 CrossRefGoogle Scholar
- 16.Mikic Z (1992) The blood supply of the human distal radioulnar joint and the microvasculature of its articular disk. Clin Orthop Relat Res 275:19–28Google Scholar
- 17.Unglaub F, Hahn P, Wolf E, Germann G, Bickert B, Sauerbier M (2007) Degeneration process of symptomatic central tears in the triangular fibrocartilage. Ann Plast Surg 59(5):515–519. https://doi.org/10.1097/01.sap.0000258958.46054.e6 CrossRefPubMedGoogle Scholar
- 20.Mrkonjic A, Geijer M, Lindau T, Tagil M (2012) The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: a 13–15 years follow-up of arthroscopically diagnosed but untreated injuries. J Hand Surg Am 37(8):1555–1560. https://doi.org/10.1016/j.jhsa.2012.05.032 CrossRefPubMedGoogle Scholar
- 22.Geissler W (ed) (2015) Wrist and elbow arthroscopy, 2nd edn. Springer, New York. ISBN 978-1-4614-1596-1Google Scholar
- 30.Blackwell RE, Jemison DM, Foy BD (2001) The holmium:yttrium-aluminum-garnet laser in wrist arthroscopy: a 5-year experience in the treatment of central triangular fibrocartilage complex tears by partial excision. J Hand Surg Am 26(1):77–84. https://doi.org/10.1053/jhsu.2001.20157 CrossRefPubMedGoogle Scholar