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Cho JY, Lee SW, Kim DH, Oh WT, Koh IH, Chun YM, Choi YR. Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex. Bone Joint J 2024; 106-B:380-386. [PMID: 38555934 DOI: 10.1302/0301-620x.106b4.bjj-2023-0642.r3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims The study aimed to assess the clinical outcomes of arthroscopic debridement and partial excision in patients with traumatic central tears of the triangular fibrocartilage complex (TFCC), and to identify prognostic factors associated with unfavourable clinical outcomes. Methods A retrospective analysis was conducted on patients arthroscopically diagnosed with Palmer 1 A lesions who underwent arthroscopic debridement and partial excision from March 2009 to February 2021, with a minimum follow-up of 24 months. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Mayo Wrist Score (MWS), and visual analogue scale (VAS) for pain. The poor outcome group was defined as patients whose preoperative and last follow-up clinical score difference was less than the minimal clinically important difference of the DASH score (10.83). Baseline characteristics, arthroscopic findings, and radiological factors (ulnar variance, MRI, or arthrography) were evaluated to predict poor clinical outcomes. Results A total of 114 patients were enrolled in this study, with a mean follow-up period of 29.8 months (SD 14.4). The mean DASH score improved from 36.5 (SD 21.5) to 16.7 (SD 14.3), the mean MWS from 59.7 (SD 17.9) to 79.3 (SD 14.3), and the mean VAS pain score improved from 5.9 (SD 1.8) to 2.2 (SD 2.0) at the last follow-up (all p < 0.001). Among the 114 patients, 16 (14%) experienced poor clinical outcomes and ten (8.8%) required secondary ulnar shortening osteotomy. Positive ulnar variance was the only factor significantly associated with poor clinical outcomes (p < 0.001). Positive ulnar variance was present in 38 patients (33%); among them, eight patients (21%) required additional operations. Conclusion Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. The presence of positive ulnar variance was associated with poor clinical outcomes, but close observation after arthroscopic debridement is more likely to be recommended than ulnar shortening osteotomy as a primary treatment.
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Affiliation(s)
- Jae-Yong Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Sung-Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Do-Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Won-Taek Oh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Il-Hyun Koh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Yun-Rak Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
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Contrast-enhanced MRI of the wrist: Intravenous application of gadolinium improves diagnosis in ulnar-sided injuries of the TFCC. Eur J Radiol 2021; 143:109901. [PMID: 34392004 DOI: 10.1016/j.ejrad.2021.109901] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE Although lesions of the triangular fibrocartilage complex (TFCC) frequently induce ulnar-sided wrist pain and potentially distal radioulnar joint instability, diagnosis can pose a challenge due to the intricate anatomy. This study aims to evaluate the benefits of contrast-enhanced sequences for the detection of TFCC injuries in magnetic resonance imaging of the wrist. METHOD 94 patients underwent wrist MRI with intravenous application of gadolinium-based contrast agents. For each patient, two datasets were analysed independently by two board-certified radiologists: One set comprised only plain T1- and fat-saturated proton-density-weighted sequences, while the second dataset included contrast-enhanced T1-weighted images with fat suppression. Arthroscopy or clinical reports served as reference standard with the former being used whenever available. Diagnostic confidence and TFCC component assessability were subjectively evaluated. Contrast-to-noise ratios (CNR) were calculated serve as an objective indicator of image contrast. RESULTS Lesions of the articular disc, the foveal and styloid ulnar attachment were present in 24 (25.5%), 61 (64.9%) and 53 (56.4%) patients. Access to contrast-enhanced T1 images improved the diagnostic accuracy for injuries of the styloid (R1/R2, 0.68/0.73 vs. 0.86/0.88) and foveal attachment (0.68/0.72 vs. 0.90/0.89) substantially compared to plain MRI (all p < 0.001), while no benefits could be identified for lesions of the central disc (0.89/0.90 vs. 0.87/0.90). Readers' diagnostic confidence and CNR for ulnar-sided lesions improved with contrast-enhanced T1 sequences available (p < 0.001). CONCLUSIONS With superior CNR in lesions of the TFCC's foveal and styloid attachment, contrast-enhanced, fat-saturated T1-weighted sequences facilitate higher diagnostic accuracy and confidence than fat-saturated PD- and plain T1-weighted MRI.
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McNamara CT, Colakoglu S, Iorio ML. A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment. J Hand Microsurg 2020; 12:116-122. [PMID: 32788827 DOI: 10.1055/s-0040-1713580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Triangular fibrocartilage complex (TFCC) injuries can present incidentally as an asymptomatic lesion or can cause acute and chronic pain. This study compared different treatment approaches for symptomatic Palmer Type 1 TFCC injuries and rates of improvement using a systematic review of the literature. Two hundred thirty-one articles were identified, 43 met criteria and were included. Two of these articles indicated conservative therapy may be adequate. Patients who underwent debridement for any Type 1 Palmer class returned to work at a rate of 92% ( n = 182), but only 44% ( n = 38) were free of pain. For 1B lesions that underwent repair, 68.3% ( n = 226) were able to return to work and 41% ( n = 52) had persistent pain. 1D lesions were treated with both repair and debridement with similar results. Data for Types 1A and 1C were limited as no authors solely addressed these lesions. For 1A lesions, those treated with traditional treatment of debridement still had high rates of being unable to return to work. The literature remains insufficient, making comparison between studies and techniques difficult. For asymptomatic injuries, there is no need for treatment. For patients with recalcitrant symptoms, surgery improves pain, grip strength, and increases return to work and activity. The level of evidence is IV.
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Affiliation(s)
- Colin T McNamara
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Salih Colakoglu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
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Crespo Romero E, Arias Arias A, Domínguez Serrano D, Palomino Nieto D, Peñuela Candel R, Sánchez Lopez D, Crespo Romero R, Picazo Belinchón J. Arthroscopic electrothermal collagen shrinkage for partial scapholunate ligament tears, isolated or with associated triangular fibrocartilage complex injuries: a prospective study. Musculoskelet Surg 2020; 105:189-194. [PMID: 32124329 DOI: 10.1007/s12306-020-00655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To present the outcomes of arthroscopic electrothermal shrinkage for partial scapholunate (SL) ligament tears, isolated or with associated triangular fibrocartilage complex (TFCC) injuries. METHODS A prospective study of 20 patients with symptomatic instability of SL ligament (14 of them also with TFCC wrist injuries) treated with arthroscopic electrothermal shrinkage was conducted using a monopolar radiofrequency probe. No patient showed radiologic signs of static dissociation (mean SL interval 2.2 ± 0.6 mm; mean SL angle 41.4° ± 6.7°) before surgery. All patients underwent follow-up at our clinic regularly for an average of 50.6 months (range 29-80 months). RESULTS The modified Mayo wrist score improved from a mean of 59 ± 17.1 points preoperatively to 88.3 ± 16.2 points at the final follow-up. At the final clinical examination, a painful Watson scaphoid shift test was found in 3 patients (15%). The mean flexion-extension arc was unchanged (132° ± 19°), and mean grip strength improved 12 kg. No patient showed radiologic signs of arthritis or instability after surgery (mean SL interval 1.9 ± 0.7 mm; mean SL angle 42.7° ± 7.3°). Of the 14 patients with combined TFCC injuries, 3 patients continued complaining of ulnar-sided point tenderness. At the end of the follow-up, 80% of the subjects were satisfied or very satisfied. CONCLUSIONS SL ligament and TFCC electrothermal shrinkage effectively provided pain relief and grip strength increase for most of the patients treated. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- E Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain.
| | - A Arias Arias
- Research Support Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, Alcázar de San Juan, Ciudad Real, Spain
| | - D Domínguez Serrano
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - D Palomino Nieto
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - R Peñuela Candel
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - D Sánchez Lopez
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - R Crespo Romero
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
| | - J Picazo Belinchón
- Orthopaedic and Traumatology Unit, Hospital Mancha-Centro, Avenida de la Constitución s/n, CP: 13600, Alcázar de San Juan, Ciudad Real, Spain
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Kloth C, Fischborn T, Preibsch H, Schmehl J. [Rare case of palmar disc dislocation after wrist distorsion]. Unfallchirurg 2019; 122:573-577. [PMID: 30767026 DOI: 10.1007/s00113-019-0613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was the elaboration of clinical symptoms and image findings in injuries of the wrist and ulnar-sided pain with accompanying damage to the articular disc and the triangular fibrocartilage complex (TFCC). MATERIAL AND METHODS This article reports about a 26-year-old male patient who presented to the department of surgery of this hospital after repeated falls onto the right wrist. Following the latest fall there was persistent wrist pain and limited movement, especially in supination. The physical examination showed pressure pain above the ulnocarpal complex; however, under forced pronation and supination no pain in the ulnocarpal complex could be triggered. RESULTS Due to the symptoms damage to the TFCC was suspected and a magnetic resonance imaging (MRI) examination of the wrist was carried out. A TFCC damage reaching as far as the dorsal radioulnar ligament involving the dorsal suspension was demarcated with dislocation and displacement of the disc. For further differentiation of the damaged structures arthrography was performed and contrast medium containing gadolinium was injected into the joint gap. The imaging showed avulsion of the dorsal triangular disc from the dorsal suspension with volar dislocation. Treatment was continued with an arthrotomy by the formation of an ulnar pedicled capsular flap, the luxated TFCC was repositioned, central frayed and torn parts were resected and smoothed. Finally, the TFCC was refixed with two 3/0 PDS U‑sutures. CONCLUSION Ulnar-sided wrist pain can be caused by a variety of clinical pathologies, so that often no diagnosis can be made based on clinical symptoms alone and an imaging method is required; however, for a clear assessment of the ligament or joint injuries an MRI is necessary. Particularly for the evaluation of the TFCC injuries MRI is a sensitive diagnostic method. In the decision making, especially when atypical injury patterns are present, an arthrography should be performed in addition to MRI to obtain the best possible information on the anatomical circumstances. KEY POINTS In cases of injuries of the wrist and ulnar-sided pain collateral damage to the articular disc and the TFCC should always be considered and excluded when appropriate. A dislocation of the disc at the wrist is a rare consequence of trauma but should be considered in the differential diagnosis. In cases of unclear MRI results and complex injuries of the wrist or unclear symptoms, MR arthrography can be helpful.
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Affiliation(s)
- Christopher Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
| | - Till Fischborn
- Klinik für Hand‑, Plastische, Rekonstruktive und Verbrennungschirurgie, Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Deutschland
| | - Heike Preibsch
- Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str.3, 72076, Tübingen, Deutschland
| | - Jörg Schmehl
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Tübingen, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076, Tübingen, Deutschland
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Arsalan-Werner A, Grüter L, Mehling IM, Moll W, Wölfle O, Sauerbier M. Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex. Arch Orthop Trauma Surg 2018; 138:731-737. [PMID: 29508106 DOI: 10.1007/s00402-018-2910-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 10/17/2022]
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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Affiliation(s)
- A Arsalan-Werner
- 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.
| | - L Grüter
- Department for Plastic and Aesthetic Surgery, Sana Hospital Düsseldorf, Gräulinger Strasse 120, 40625, Düsseldorf, Germany
| | - I M Mehling
- Department for Hand Surgery, St. Vinzenz Hospital Hanau gGmbH, Am Frankfurter Tor 25, 63450, Hanau, Germany
| | - W Moll
- 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
| | - O Wölfle
- Department for Plastic, Hand- and Reconstructive Surgery, Main-Taunus Hospitals GmbH, Kronberger Strasse 36, 65812, Bad Soden am Taunus, Germany
| | - M Sauerbier
- 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
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Farr S, Schüller M, Ganger R, Girsch W. Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents. J Wrist Surg 2018; 7:43-50. [PMID: 29383275 PMCID: PMC5788757 DOI: 10.1055/s-0037-1604394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Background To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. Purpose The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. Materials and Methods We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE). Results Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome. Conclusion Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Sebastian Farr
- Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
| | - Marion Schüller
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital Speising, Vienna, Austria
| | - Rudolf Ganger
- Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
| | - Werner Girsch
- Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
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A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear. Plast Reconstr Surg 2017; 140:697e-708e. [PMID: 29068932 DOI: 10.1097/prs.0000000000003750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears. METHODS The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications. RESULTS A total of 1723 unique studies were identified, of which 18 studies met the authors' criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work. CONCLUSIONS Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.
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Weinstock-Zlotnick G, Mehta SP. A structured literature synthesis of wrist outcome measures: An evidence-based approach to determine use among common wrist diagnoses. J Hand Ther 2017; 29:98-110. [PMID: 27264897 DOI: 10.1016/j.jht.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Structured literature synthesis. INTRODUCTION Hand therapists and researchers have numerous options when selecting outcome measures for patients with wrist pathologies. An evidence-based approach to determining which measures are used most often can inform choices. PURPOSE OF THE STUDY To describe how frequently outcome measures are used in recent randomized controlled trials of patients with wrist diagnoses. Identifying assessment design and related International Classification of Functioning, Disability and Health (ICF) domains provides additional consideration for selection. METHODS Systematic PubMed and Cumulative Index to Nursing and Allied Health Literature searches for the time frame between January 2005 and March 2015 captured measures used in randomized controlled trials researching wrist-specific fractures, ligament injuries, nerve injuries, arthritis/arthroplasty, or stress injuries/wrist pain. RESULTS Three most frequent measures used within each diagnostic category are detailed with assessment design described and ICF domain identified. Across diagnoses, grip/pinch strength and Disabilities of Arm, Shoulder and Hand were the most frequently used physical and patient-reported outcome measures, respectively. The Jebsen-Taylor Hand Function Test was the most frequently used performance measure. DISCUSSION AND CONCLUSIONS Consideration of the evidence, ICF domains, wrist diagnoses, and assessment design can help hand therapists select the measure most appropriate for use. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
| | - Saurabh P Mehta
- School of Physical Therapy, Marshall University, Huntington, WV, USA; Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
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Huber M, Loibl M, Eder C, Kujat R, Nerlich M, Gehmert S. Effects on the Distal Radioulnar Joint of Ablation of Triangular Fibrocartilage Complex Tears With Radiofrequency Energy. J Hand Surg Am 2016; 41:1080-1086. [PMID: 27663055 DOI: 10.1016/j.jhsa.2016.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 07/14/2016] [Accepted: 08/12/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE This cadaver study investigated the temperature profile in the wrist joint and distal radioulnar joint (DRUJ) during radiofrequency energy (RFE) application for triangular fibrocartilage complex resection. METHODS An arthroscopic partial resection of the triangular fibrocartilage complex using monopolar and bipolar RFE was simulated in 14 cadaver limbs. The temperature was recorded simultaneously in the DRUJ and at 6 other anatomic locations of the wrist during RFE application. RESULTS The mean temperature in the DRUJ was 43.3 ± 8.2°C for the bipolar system in the ablation mode (60 W) and 30.4 ± 3.4°C for the monopolar system in the cut mode (20 W) after 30 seconds. The highest measured temperature in the DRUJ was 54.3°C for the bipolar system and 68.1°C for the monopolar system. CONCLUSIONS The application of RFE for debridement or resection of the triangular fibrocartilage complex in a clinical setting can induce peak temperatures that might cause damage to the cartilage of the DRUJ. Bipolar systems produce higher mean temperatures than monopolar devices. CLINICAL RELEVANCE RFE application increases the mean temperature in the DRUJ after 30 seconds to a level that may jeopardize cartilage tissue.
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Affiliation(s)
- Michaela Huber
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Markus Loibl
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christoph Eder
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Richard Kujat
- Center for Medical Biotechnology, University of Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sebastian Gehmert
- Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
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Pirolo JM, Le W, Yao J. Effect of Electrothermal Treatment on Nerve Tissue Within the Triangular Fibrocartilage Complex, Scapholunate, and Lunotriquetral Interosseous Ligaments. Arthroscopy 2016; 32:773-8. [PMID: 26947354 DOI: 10.1016/j.arthro.2015.11.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 10/31/2015] [Accepted: 11/20/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of thermal treatment on neural tissue in the triangular fibrocartilage complex (TFCC), scapholunate interosseous ligament (SLIL), and lunotriquetral interosseous ligament (LTIL). METHODS The intact TFCC, SLIL, and LTIL were harvested from cadaveric specimens and treated with a radiofrequency probe as would be performed intraoperatively. Slides were stained using a triple-stain technique for neurotrophin receptor p75, pan-neuronal marker protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole for neural identification. Five TFCC, 5 SLIL, and 4 LTIL specimens were imaged with fluorescence microscopy. Imaging software was used to measure fluorescence signals and compare thermally treated areas with adjacent untreated areas. A paired t test was used to compare treated versus untreated areas. P < .05 was considered significant. RESULTS For the TFCC, a mean of 94.9% ± 2.7% of PGP 9.5-positive neural tissue was ablated within a mean area of 11.7 ± 2.5 mm(2) (P = .02). For the SLIL treated from the radiocarpal surface, 97.4% ± 1.0% was ablated to a mean depth of 2.4 ± 0.3 mm from the surface and a mean horizontal spread of 3.4 ± 0.5 mm (P = .01). For the LTIL, 96.0% ± 1.5% was ablated to a mean depth of 1.7 ± 0.7 mm and a mean horizontal spread of 2.6 ± 1.0 mm (P = .02). Differences in the presence of neural tissue between treated areas and adjacent untreated areas were statistically significant for all specimens. CONCLUSIONS Our study confirms elimination of neuronal markers after thermal treatment of the TFCC, SLIL, and LTIL in cadaveric specimens. This effect penetrates below the surface to innervated collagen tissue that is left structurally intact after treatment. CLINICAL RELEVANCE Electrothermal treatment as commonly performed to treat symptomatic SLIL, LTIL, and TFCC tears eliminates neuronal tissue in treated areas and may function to relieve pain through a denervation effect.
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Affiliation(s)
- Joseph M Pirolo
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Wei Le
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Palo Alto, California, U.S.A..
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Bayoumy MA, Elkady HA, Said HG, El-Sayed A, Saleh WR. Short-term evaluation of arthroscopic outside-in repair of ulnar side TFCC tear with vertical mattress suture. J Orthop 2015; 13:455-460. [PMID: 27857481 DOI: 10.1016/j.jor.2015.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND There has been controversy regarding the pathogenesis and treatment of TFCC tear. Different surgical techniques for the treatment of TFCC are prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic outside-in repair of the ulnar side TFCC tear with vertical mattress suture. METHODS In this study, arthroscopic outside-in repair of the ulnar side TFCC tear was done. 37 patients with TFCC tear with failure of conservative treatment for a minimum of 6 months had surgery. Outcomes were assessed using modified Mayo wrist score (MMWS), the Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS) for pain and satisfaction criteria, and patient-related wrist evaluation score (PRWE), in addition to the range of motion and grip strength. RESULTS After arthroscopic surgery, overall satisfaction was extremely positive, and out of the 37 patients, 91.9% of the patients are satisfied. The mean score for pain improved from 7.6 to 2.9 points. The mean MMWS was improved from 62.1 to 91.2 points. DASH score also improved from 29.9 to 10.2 points and PRWE improved from 60 to 33 points. The ROM was improved from 85.8% to 92% of the normal side. The grip strength of the affected side improved from 82.5% to 89% of the normal side. All improvements are statistically significant (P < 0.05). CONCLUSION Arthroscopic outside-in repair of ulnar side TFCC tear with mattress suture is a reproducible method with a marked improvement in function within a short period.
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Affiliation(s)
| | - Hesham A Elkady
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut 71111, Egypt
| | - Hatem G Said
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut 71111, Egypt
| | - Amr El-Sayed
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut 71111, Egypt
| | - Waleed Riad Saleh
- Orthopaedic and Traumatology Department, Assiut University Hospital, Assiut 71111, Egypt
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Pirolo JM, Yao J. Current surgical treatment options for triangular fibrocartilage complex tears. CURRENT ORTHOPAEDIC PRACTICE 2014. [DOI: 10.1097/bco.0000000000000148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Ulnar-sided wrist pain is a common cause of pain and disability, which has long been a diagnostic and therapeutic dilemma for hand surgeons. A thorough understanding of the anatomy, clinical examination, and radiographic evaluation is essential to establish a focused differential diagnosis, with the cause of disability often being multifactorial. Arthroscopy is particularly well suited to both directly visualize and treat multiple causes of ulnar-sided wrist pain, including pathology of the TFCC, UIS, LTIL tears, and hamate arthrosis.
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Affiliation(s)
- Joseph M Pirolo
- Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, 450 Broadway Street, M/C 6342, Redwood City, CA 94063, USA
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