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Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex

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Abstract

Introduction

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.

Results

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.

Conclusions

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.

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Acknowledgements

We thank our librarian Claudia Diemann-Paeth for helping with the literature research.

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Authors and Affiliations

  1. Department for Plastic, Hand and Reconstructive Surgery, Hand Trauma Center, BG-Trauma Center Frankfurt am Main, Academic Hospital of the Johann Wolfgang Goethe-University Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany

    A. Arsalan-Werner, W. Moll & M. Sauerbier

  2. Department for Plastic and Aesthetic Surgery, Sana Hospital Düsseldorf, Gräulinger Strasse 120, 40625, Düsseldorf, Germany

    L. Grüter

  3. Department for Hand Surgery, St. Vinzenz Hospital Hanau gGmbH, Am Frankfurter Tor 25, 63450, Hanau, Germany

    I. M. Mehling

  4. Department for Plastic, Hand- and Reconstructive Surgery, Main-Taunus Hospitals GmbH, Kronberger Strasse 36, 65812, Bad Soden am Taunus, Germany

    O. Wölfle

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  1. A. Arsalan-Werner
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Corresponding author

Correspondence to A. Arsalan-Werner.

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All authors declare that they have no conflict of interest.

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The institutional ethics committee approved the study design.

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Arsalan-Werner, A., Grüter, L., Mehling, I.M. et al. Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex. Arch Orthop Trauma Surg 138, 731–737 (2018). https://doi.org/10.1007/s00402-018-2910-4

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