1
|
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
2
|
Zhao X, Sun J, Duan F, Xin F, Shi LL, Yu T. Qualitative and Quantitative Anatomy of the Deep Radioulnar Ligaments' Insertion on Ulna: Cadaveric, Histologic, and MRI Study. J Hand Surg Am 2024; 49:377.e1-377.e9. [PMID: 35931631 DOI: 10.1016/j.jhsa.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/09/2022] [Accepted: 06/01/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To qualitatively and quantitatively analyze the anatomic features of the insertion of deep radioulnar ligaments (RULs) and provide an anatomic basis for further studies. METHODS The anatomic features of deep RUL insertion were observed macroscopically in 26 cadaveric wrists, after which the size of the deep RUL footprint and distance from the center of the footprint to the ulnar-sided margin of articular cartilage of the ulnar head were each measured. Five specimens were analyzed histologically to examine the attachment of the RUL on the ulna. In addition, we evaluated 21 asymptomatic wrists from healthy volunteers using 3.0 T magnetic resonance imaging. RESULTS The insertion of the deep RUL was located mainly on the radial aspect of the ulnar fovea from the foveal center to the articular cartilage. The footprint of the deep RUL appeared in 3 different shapes. The maximal width, length, and area of the footprint of the deep RUL were 3.7 (95% confidence interval [CI], 3.3-4.0) mm, 8.4 (95% CI, 7.9-8.9) mm, and 26.3 (95% CI, 23.4-29.1) mm2, respectively. Histologic analyses showed the attachment of the deep RUL on the radial wall of the fovea exhibited a direct insertion with typical 4-layer structures. The deep RUL fibers formed an acute angle with the distal component of the triangular fibrocartilage complex. CONCLUSIONS The deep RUL was inserted on the radial side of the ulnar fovea and not the foveal center; it had direct insertion on the radial wall continuous with articular cartilage, and the fibers in the direct insertion formed an acute angle with the distal component of the triangular fibrocartilage complex. CLINICAL RELEVANCE Understanding the quantitative anatomy of the deep RUL insertion may help guide surgeons to perform an anatomic foveal repair of the triangular fibrocartilage complex in its native footprint.
Collapse
Affiliation(s)
- Xia Zhao
- Department of Orthopaedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jie Sun
- Department of Orthopaedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Feng Duan
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fangjie Xin
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lewis L Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Tengbo Yu
- Department of Orthopaedic Surgery, the Affiliated Hospital of Qingdao University, Qingdao, China.
| |
Collapse
|
3
|
Nakamura T. Classifications of Triangular Fibrocartilage Complex Lesions. J Wrist Surg 2024; 13:1. [PMID: 38264127 PMCID: PMC10803149 DOI: 10.1055/s-0043-1778082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
4
|
Crowe CS, Kakar S. Structurally intact and functionally incompetent foveal triangular fibrocartilage complex injuries : an under-recognized spectrum of injury. Bone Joint J 2023; 105-B:5-10. [PMID: 36587253 DOI: 10.1302/0301-620x.105b1.bjj-2022-0908.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Injury to the triangular fibrocartilage complex (TFCC) may result in ulnar wrist pain with or without instability. One component of the TFCC, the radioulnar ligaments, serve as the primary soft-tissue stabilizer of the distal radioulnar joint (DRUJ). Tears or avulsions of its proximal, foveal attachment are thought to be associated with instability of the DRUJ, most noticed during loaded pronosupination. In the absence of detectable instability, injury of the foveal insertion of the radioulnar ligaments may be overlooked. While advanced imaging techniques such as MRI and radiocarpal arthroscopy are well-suited for diagnosing central and distal TFCC tears, partial and complete foveal tears without instability may be missed without a high degree of suspicion. While technically challenging, DRUJ arthroscopy provides the most accurate method of detecting foveal abnormalities. In this annotation the spectrum of foveal injuries is discussed and a modified classification scheme is proposed.Cite this article: Bone Joint J 2023;105-B(1):5-10.
Collapse
Affiliation(s)
| | - Sanj Kakar
- Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
5
|
Nakamura T, Takagi T. Differentiated Approaches to Treat Lesions of the TFCC Based on new arthroscopic Classification. HANDCHIR MIKROCHIR P 2022; 54:389-398. [PMID: 36037815 DOI: 10.1055/a-1872-0109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this article, pathology of the TFCC lesions, image diagnosis and arthroscopic examination were described. According to the radiocarpal arthroscopic findings, TFCC lesions are classified into intra-disc lesions (Class 1), radial lesion (Class 2), peripheral disc lesions which indicate slight to moderate DRUJ instability (Class 3) and degenerative lesion (Class 4). The radioulnar ligament (RUL) lesions that indicate moderate to severe DRUJ instability were classified with staging system with DRUJ arthroscopic findings (Stage 1 to 5). Author's treatment algorism with wrist arthroscopic findings including DRUJ arthroscopy was demonstrated and along with this algorism, various arthroscopic and open techniques to treat TFCC injuries were selected and resulted in success. Precise diagnosis of the TFCC lesions helped to select an adequate treatment for each lesion.Dieser Artikel beschreibt die pathologischen Veränderungen des TFCC sowie deren Befunde in der Bildgebung und Arthroskopie. Am TFCC lassen sich mittels Arthroskopie bei Sicht von radiokarpal zentrale (Typ 1), radiale (Typ 2) sowie periphere Läsionen (Typ 3), die mit einer moderaten Instabilität des distalen Radioulnargelenkes (DRUG) einhergehen, und degenerative Läsionen (Typ 4) unterscheiden. Läsionen der radioulnaren Bänder, die mit einer moderaten bis ausgeprägten Instabilität des DRUG vergesellschaftet sind, werden anhand der Befunde bei der DRUG-Arthroskopie in fünf Stadien eingeteilt. Diesen unterschiedlichen Befunden angepasst wurde ein Behandlungsalgorithmus mit verschiedenen arthroskopischen und offenen Verfahren entwickelt, der sich als erfolgreich erwies. Eine exakte Klassifizierung von TFCC-Läsionen ermöglicht die Wahl des für die jeweilige Läsion adäquaten Therapieverfahrens.
Collapse
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan.,Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
| | - Takehilko Takagi
- Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
| |
Collapse
|
6
|
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
7
|
Abstract
Background The field of arthroscopy has exponentially grown in the past decade, especially in the realm of upper extremity surgery. Description The use of smaller cameras and further advancements in arthroscopy technology have allowed innovative expansion in the application of arthroscopy in small joints. Clinical Relevance Included in the advancements is the NanoScope, a 1.9-mm flexible scope specifically designed for small joint visualization.
Collapse
Affiliation(s)
- Christine Oh
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
8
|
De Santis S, Cozzolino R, Luchetti R, Cazzoletti L. Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex. J Wrist Surg 2022; 11:28-34. [PMID: 35127261 PMCID: PMC8807093 DOI: 10.1055/s-0041-1729757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis. Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection. Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I-III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings. Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases. Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage. Level of Evidence This is a Level II, retrospective comparative study.
Collapse
Affiliation(s)
| | | | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| |
Collapse
|
9
|
Abstract
Background Arthroscopy of the distal radioulnar joint is considered to be difficult to perform. At this time the integrity of the foveal insertion is indirectly evaluated with a hook test. If a hook test is positive it is inferred that the foveal insertion is torn or incompetent. Description of Technique The ideal way to evaluate the foveal insertion is by direct visualization and probing. In order to do this, arthroscopic examination of the distal radioulnar joint and foveal insertion is required. The article describes how to reliably perform "dry" arthroscopy of the distal radioulnar joint and foveal insertion using a 1.9 mm arthroscope to accurately assess the triangular fibrocartilage complex and foveal insertion. Patient and Methods A total of 169 dry DRUJ arthroscopies were performed by the primary author between January 2018 and February 2021. Results Using this technique, the foveal insertion was successfully visualized in 168 cases (99%). Conclusion Dry arthroscopy of the DRUJ is a reliable technique to evaluate the integrity of the foveal insertion.
Collapse
Affiliation(s)
- Jeff Ecker
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
- Hand and Upper Limb Centre, Claremont, Western Australia, Australia
| | - Courtney Andrijich
- Jeff Ecker Clinic, Bethesda Hospital, Claremont, Western Australia, Australia
| |
Collapse
|
10
|
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| |
Collapse
|
11
|
Abstract
Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. In this review, world leaders of wrist arthroscopy describe bone graft for scaphoid nonunion, transosseous repair for triangular fibrocartilage fovea avulsion, palmaris longus reconstruction of the triangular fibrocartilage, and arthroscopic reconstruction of the scapholunate and lunotriquetral ligaments.
Collapse
Affiliation(s)
- Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Pak Cheong Ho
- Department of Orthopaedic & Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy
| | - Fernando Corella
- Hand Surgery Unit, Orthopadic and Trauma Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | |
Collapse
|
12
|
Hung CH, Kuo YF, Chen YJ, Yeh PC, Cho HY, Chen YJ. Comparative outcomes between all-inside arthroscopic suture anchor technique versus arthroscopic transosseous suture technique in patients with triangular fibrocartilage complex tear: a retrospective comparative study. J Orthop Surg Res 2021; 16:600. [PMID: 34649578 PMCID: PMC8515735 DOI: 10.1186/s13018-021-02752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Triangular fibrocartilage complex (TFCC) has become an interest over the last few decades, discovering its understanding in anatomy, pathomechanism, biomechanics, and management in treatments. Currently, TFCC does not have a golden standard procedure, and not one surgical procedure is superior to the other. This study is to evaluate the comparative outcomes in TFCC patients that underwent either in all-inside arthroscopic suture anchors or the arthroscopic transosseous suture technique. Method From 2017 to 2019, 30 patients were analyzed. Eight patients were in an arthroscopic transosseous group and 22 patients were in an all-inside arthroscopic group. Comparison between patients’ flexion and extension range of motion (ROM), grip strength, and visual analog pain scale (VAS) preoperative and six-month follow-up were analyzed. Result There were significant increases in flexion ROM, extension ROM, and VAS between preoperative and postoperative in all-inside arthroscopic and arthroscopic transosseous. Only the all-inside arthroscopic group had a significant increase in grip strength. Postoperative flexion ROM had a significant difference between all-inside arthroscopic and arthroscopic transosseous. Conclusion Both the all-inside arthroscopic suture anchor technique and the arthroscopic transosseous suture technique are appropriate treatments to treat patients with TFCC. Both procedures have achieved the ultimate goal of improved longevity and optimal function. Level of evidence Level III; retrospective comparative cohort study.
Collapse
Affiliation(s)
- Chia-Hung Hung
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Yu-Feng Kuo
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC
| | - Yu-Jen Chen
- Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Ping-Chun Yeh
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Hsiao-Yun Cho
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC.,Department of Otorhinolaryngology, Head of Neck and Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, 24352, Taiwan, ROC
| | - Yeong-Jang Chen
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC. .,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.
| |
Collapse
|
13
|
Abstract
Background The triangular fibrocartilage complex (TFCC) lesions are frequently implicated as a cause of ulnar wrist pain following impact and loading injuries. The objective of this study was to describe the clinical outcomes following TFCC lesion repair with the arthroscopic outside-in technique. Description of Technique We inserted a 21-gauge needle with 4-0 nylon loop perpendicular to the injured triangular fibrocartilage (TFC). We held two 4-0 nylon loops with mosquito forceps, drew them once out of the joint through a 4 to 5 portal, and put both sides through each loop. After that, we pulled out the 21-gauge needles and performed outside-in sutures after making a small incision and tying directly over the capsule. Patients and Methods Twenty-one wrists who underwent arthroscopic capsular repair were included. Arthroscopic findings were evaluated, and we used a distal radioulnar joint (DRUJ) evaluation system to monitor relief of pain, forearm rotation range of motion, and DRUJ stability postoperatively. Results Simple ulnar avulsion (Palmer 1B, Atzei Class 1) was recognized in ten wrists. A combination of the 1B tear with a horizontal TFC tear was noted in five wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in six wrists, including complete dorsal avulsion of the TFC from the capsule. There are significantly better results in the cases whose preoperative periods were 15 months or less. Conclusion The outside-in TFC repair technique produced excellent clinical results for peripheral detachment of the TFC in cases without severe DRUJ instability and with a preoperative period less than 15 months.
Collapse
Affiliation(s)
- Takehiko Takagi
- Department of Surgical Specialties, Division of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiyasu Nakamura
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Masatoshi Fukuoka
- Department of Orthopaedic Surgery, Saitama City Hospital, Saitama, Japan
| |
Collapse
|
14
|
Atzei A, Luchetti R, Carletti D, Marcovici LL, Cazzoletti L, Barbon S. The Hook Test Is More Accurate Than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist. Arthroscopy 2021; 37:1800-1807. [PMID: 33745938 DOI: 10.1016/j.arthro.2021.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the accuracy of the trampoline and hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared with arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). METHODS In total, 135 patients (97 male, 38 female, mean age 43.5 years) were divided into 2 groups: (1) 80 patients with chronic ulnar-sided wrist pain and positive fovea sign and (2) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy and by the trampoline and hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity, and likelihood ratio of the 2 diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference. RESULTS The trampoline and the hook tests showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the trampoline test was similar for distal (69%), proximal (66%), and complete (73%) TFCC tears. The hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for the trampoline and hook tests was 75.00% and 0.00% (P < .001) for distal tears and 78.85% and 100.00% (P < .001) and 58.33% and 100.00% (P < .001) for complete or isolated proximal tears, respectively. Specificity for the trampoline and hook tests was 67.27% and 96.36% (P < .001) respectively. CONCLUSIONS The trampoline and hook tests can assure accurate diagnosis of peripheral TFCC tear. The hook test shows greater specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a greater probability to detect foveal laceration of peripheral TFCC for the hook test than for the trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal incompetence of the TFCC, if the hook test is positive. LEVEL OF EVIDENCE Level II, retrospective diagnostic trial.
Collapse
Affiliation(s)
- Andrea Atzei
- PRO-Mano, Hand Surgery and Rehabilitation Center, Treviso, Italy Hand Surgery Unit, Ospedale Koelliker, Torino.
| | | | | | | | - Lucia Cazzoletti
- Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona
| | - Silvia Barbon
- Department of Neurosciences, University of Padua, Padua, Italy
| |
Collapse
|
15
|
Liu B, Fok MWM. The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal reconstruction using tendon graft. Int Orthop 2021; 45:1273-1279. [PMID: 33619584 DOI: 10.1007/s00264-021-04976-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE In patients with symptomatic chronic tear of the triangular fibrocartilage complex (TFCC), reconstruction with a tendon graft is indicated. We propose an arthroscopic-assisted technique to reconstruct the TFCC and to stabilize the distal radioulnar joint. METHODS Patients with a chronic foveal TFCC tear of which it is deem not reparable were recruited. TFCC reconstruction was performed by making use of the TFCC remnants and a palmaris tendon graft under arthroscopic guidance. RESULTS Twelve patients with an average age of 29 years old were evaluated. Three patients had concomitant ulnar shortening procedure. The average follow-up period was 29 months. All patients had stable DRUJ. Significant improvement was noted for pain score (from 4 to 1), DASH score (from 31 to 9.5), and Mayo modified wrist score (from 82 to 95). Grip strength was improved and the range of movement of the wrist was maintained. No complication nor graft re-rupture was noted. CONCLUSION This is a viable arthroscopic technique of TFCC reconstruction in a selected group of patients who had chronic foveal TFCC tear.
Collapse
Affiliation(s)
- Bo Liu
- Department of Hand Surgery, Ji Shui Tan Hospital, The 4th Clinical College of Peking University, Beijing, China
| | - Margaret Woon Man Fok
- Department of Orthopaedics and Traumatology, Hong Kong Special Administrative Region, Queen Mary Hospital, The University of Hong Kong, 5/F, Professorial Block, Pokfulam Road, Hong Kong.
| |
Collapse
|
16
|
Liu B, Arianni M. Arthroscopic Ligament-specific Repair for Triangular Fibrocartilage Complex Foveal Avulsion: A Novel Technique. Tech Hand Up Extrem Surg 2020; 24:175-81. [PMID: 32412983 DOI: 10.1097/BTH.0000000000000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The deep components of the triangular fibrocartilage complex (TFCC), which consist of the volar and dorsal radioulnar ligaments (RULs), are crucial for maintaining stability of the distal radioulnar joint. Avulsion of the volar and dorsal RULs from their foveal insertions must thus be diagnosed and treated correctly. We describe our arthroscopic technique for TFCC foveal repair (arthroscopic ligament-specific transosseous repair), in which we repair each of the dorsal and volar RUL to separate points on the fovea. With this "ligament-specific" repair we wish to restore the normal anatomy and physiology of the TFCC.
Collapse
|
17
|
Greene RM, Kakar S. The Suction Test: A Novel Technique to Identify and Verify Successful Repair of Peripheral Triangular Fibrocartilage Complex Tears. J Wrist Surg 2017; 6:334-335. [PMID: 29085736 PMCID: PMC5658226 DOI: 10.1055/s-0037-1599125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
Background The diagnoses of peripheral triangular fibrocartilage complex (TFCC) tears continue to be the subject of numerous investigations. Case Description We describe a novel arthroscopic technique that may be used as an adjunct with other arthroscopic maneuvers to diagnose and confirm repair of peripheral sided TFCC injuries. Literature Review The hook and trampoline tests are intraoperative techniques to diagnose TFCC tears. Clinical Relevance The suction test provides a means to detect peripheral tears and to confirm restoration of its tension post repair.
Collapse
Affiliation(s)
- Ryan M. Greene
- Division of Hand Surgery, Department of Orthopedic Surgery, The Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Division of Hand Surgery, Department of Orthopedic Surgery, The Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
18
|
Abstract
This article shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears, whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint. Understanding these trends can help clinicians best treat TFCC tears.
Collapse
|
19
|
Löw S, Spies CK, Unglaub F, van Schoonhoven J, Prommersberger KJ, Mühldorfer-Fodor M. Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases. J Wrist Surg 2017; 6:33-38. [PMID: 28119793 PMCID: PMC5258130 DOI: 10.1055/s-0036-1584311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
Background Frequently, patients undergo repeated wrist arthroscopies for single wrist problems. Purpose The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures. Methods For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies. Results Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists. Conclusion In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures. Level of Evidence Level IV.
Collapse
Affiliation(s)
- Steffen Löw
- Section of Hand Surgery, Division of Trauma and Orthopedic Surgery, Caritas Krankenhaus, Bad Mergentheim, Germany
| | | | - Frank Unglaub
- Department of Hand Surgery, Vulpius Klinik, Bad Rappenau, Germany
| | | | | | | |
Collapse
|
20
|
Abstract
Background Since 1998, we treated 25 wrists with foveal detachment of the triangular fibrocartilage complex (TFCC) by our original reattachment technique using a half-slip of the extensor carpi ulnaris (ECU) tendon with a very small titanium interference screw. We examine the clinical outcome of this procedure with a minimum of 2 years follow-up. Patients and Methods There were 25 wrists of 24 patients (16 right, 7 left, 1 bilateral, mean age, 34.8 years) with a minimum follow-up of 2 years (range 2-7 years, average 3.1). There was a neutral ulnar variance in 19 wrists and positive in 6. In the positive-variance wrists, an ulnar shortening was performed to prevent ulnar abutment before the reattachment. The diagnosis of a TFCC injury was done by arthrogram, magnetic resonance imaging (MRI), and distal radioulnar (DRUJ) arthroscopy. The clinical outcome was evaluated using our original DRUJ evaluating system. Technique A distally based ECU half-slip was harvested, introduced into the TFCC, sutured to the remnant of the TFCC, and pulled out through a 2.5-mm bone tunnel at the center of the fovea. The ECU half-slip was subsequently anchored to the ulnar fovea with a small titanium interference screw. Results At the final follow-up, 21 wrists had no pain, 3 wrists indicated mild pain, and 1 wrist severe pain. One patient had a loss of supination by 30 degrees. The DRUJ was stable in 22 wrists, moderately unstable in 2 wrists, and severely unstable in 1 wrist. There were 21 excellent, 2 good, 1 fair, and 1 poor results. Conclusions Anatomic reattachment of the TFCC to the ulnar fovea using an ECU half-slip tendon is a promising procedure. This technique is effective for severe DRUJ instability due to chronic foveal avulsion of the TFCC.
Collapse
Affiliation(s)
- Toshiyasu Nakamura
- Clinical Research Center, International University of Health and Welfare, Department of Orthopaedic Surgery, Sanno Hospital, Tokyo, Japan
| |
Collapse
|