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Erschienen in: International Orthopaedics 5/2021

22.02.2021 | Original Paper

The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal reconstruction using tendon graft

verfasst von: Bo Liu, Margaret Woon Man Fok

Erschienen in: International Orthopaedics | Ausgabe 5/2021

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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.
Literatur
1.
Zurück zum Zitat Palmer AK (1987) The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clinics Hand Clin 3(1):31–40CrossRef Palmer AK (1987) The distal radioulnar joint. Anatomy, biomechanics, and triangular fibrocartilage complex abnormalities. Hand Clinics Hand Clin 3(1):31–40CrossRef
2.
Zurück zum Zitat Atzei A, Luchetti R (2011) Foveal TFCC tear classification and treatment. Hand Clinics 27(3):263–272CrossRef Atzei A, Luchetti R (2011) Foveal TFCC tear classification and treatment. Hand Clinics 27(3):263–272CrossRef
3.
Zurück zum Zitat Hui FC, Linscheid RL (1982) Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 7(3):230–236CrossRef Hui FC, Linscheid RL (1982) Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 7(3):230–236CrossRef
4.
Zurück zum Zitat Scheker LR, Belliappa PP, ACOSTA R, GERMAN DS (1994) Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J of Hand Surg Br 19(3):310–318CrossRef Scheker LR, Belliappa PP, ACOSTA R, GERMAN DS (1994) Reconstruction of the dorsal ligament of the triangular fibrocartilage complex. J of Hand Surg Br 19(3):310–318CrossRef
5.
Zurück zum Zitat Adams BD (2000) Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg 4(3):154–160CrossRef Adams BD (2000) Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg 4(3):154–160CrossRef
6.
Zurück zum Zitat Shih J-T, Hou Y-T, Lee H-M, Tan C-M (2000) Chronic triangular fibrocartilage complex tears with distal radioulnar joint instability: a new method of triangular fibrocartilage complex reconstruction. J Orthop Surg 8(1):1–8CrossRef Shih J-T, Hou Y-T, Lee H-M, Tan C-M (2000) Chronic triangular fibrocartilage complex tears with distal radioulnar joint instability: a new method of triangular fibrocartilage complex reconstruction. J Orthop Surg 8(1):1–8CrossRef
7.
Zurück zum Zitat Tse W-L, Lau S-W, Wong WY, Cheng H-S, Chow C-S, Ho P-C et al (2013) Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability. Injury 44(3):386–390CrossRef Tse W-L, Lau S-W, Wong WY, Cheng H-S, Chow C-S, Ho P-C et al (2013) Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability. Injury 44(3):386–390CrossRef
8.
Zurück zum Zitat Meyer D, Schweizer A, Nagy L (2017) anatomic reconstruction of distal radioulnar ligaments with tendon graft for treating distal radioulnar joint instability: surgical technique and outcome. Tech Hand Up Extrem Surg 21(3):107–113CrossRef Meyer D, Schweizer A, Nagy L (2017) anatomic reconstruction of distal radioulnar ligaments with tendon graft for treating distal radioulnar joint instability: surgical technique and outcome. Tech Hand Up Extrem Surg 21(3):107–113CrossRef
9.
Zurück zum Zitat Atzei A. (2012) DRUJ Instability: arthroscopic ligament reconstruction. In: Arthroscopic Management of Ulnar Pain. Berlin, Heidelberg: Springer, Berlin, Heidelberg; p.147–60. Atzei A. (2012) DRUJ Instability: arthroscopic ligament reconstruction. In: Arthroscopic Management of Ulnar Pain. Berlin, Heidelberg: Springer, Berlin, Heidelberg; p.147–60.
10.
Zurück zum Zitat Nakamura T, Matsumura N, Iwamoto T, Sato K, Toyama Y (2014) Arthroscopy of the distal radioulnar joint. Handchir Mikrochir Plast Chir 46(5):295–299PubMed Nakamura T, Matsumura N, Iwamoto T, Sato K, Toyama Y (2014) Arthroscopy of the distal radioulnar joint. Handchir Mikrochir Plast Chir 46(5):295–299PubMed
11.
Zurück zum Zitat 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):92–97CrossRef 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):92–97CrossRef
12.
Zurück zum Zitat Nakamura T (2015) Anatomical reattachment of the TFCC to the ulnar fovea using an ECU half-slip. J Wrist Surg 4(1):p15–p21CrossRef Nakamura T (2015) Anatomical reattachment of the TFCC to the ulnar fovea using an ECU half-slip. J Wrist Surg 4(1):p15–p21CrossRef
13.
Zurück zum Zitat Nakamura R, Horii E, Imaeda T et al (1997) The ulnocarpal stress test in the diagnosis of ulnar side wrist pain. J hand Surg Br 22(6):719–723CrossRef Nakamura R, Horii E, Imaeda T et al (1997) The ulnocarpal stress test in the diagnosis of ulnar side wrist pain. J hand Surg Br 22(6):719–723CrossRef
14.
Zurück zum Zitat Liu B, Fok MWM (2017) All arthroscopic reconstruction of chronic foveal triangular fibrocartilage complex tears with a tendon graft. Asian J Arthrosc 2(2):8–10 Liu B, Fok MWM (2017) All arthroscopic reconstruction of chronic foveal triangular fibrocartilage complex tears with a tendon graft. Asian J Arthrosc 2(2):8–10
15.
Zurück zum Zitat Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14(4):594–606CrossRef Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14(4):594–606CrossRef
16.
Zurück zum Zitat Tsai TM, Stilwell JH (1984) Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg Br 9(3):289–294CrossRef Tsai TM, Stilwell JH (1984) Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg Br 9(3):289–294CrossRef
17.
Zurück zum Zitat Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27(2):243–251CrossRef Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27(2):243–251CrossRef
18.
Zurück zum Zitat Shih J-T, Lee H-M (2005) Functional results post-triangular fibrocartilage complex reconstruction with extensor carpi ulnaris with or without ulnar shortening in chronic distal radioulnar joint instability. Hand Surg 10(2-3):169–176CrossRef Shih J-T, Lee H-M (2005) Functional results post-triangular fibrocartilage complex reconstruction with extensor carpi ulnaris with or without ulnar shortening in chronic distal radioulnar joint instability. Hand Surg 10(2-3):169–176CrossRef
19.
Zurück zum Zitat Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA (2008) Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 33(5):675–682CrossRef Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA (2008) Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 33(5):675–682CrossRef
20.
Zurück zum Zitat Papapetropoulos PA, Ruch DS (2009) Repair of arthroscopic triangular fibrocartilage complex tears in athletes. Hand Clinics 25(3):389–394CrossRef Papapetropoulos PA, Ruch DS (2009) Repair of arthroscopic triangular fibrocartilage complex tears in athletes. Hand Clinics 25(3):389–394CrossRef
21.
Zurück zum Zitat Yao J (2011) All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clinics 27(3):237–242CrossRef Yao J (2011) All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clinics 27(3):237–242CrossRef
22.
Zurück zum Zitat ABE Y, Fujii K, Fujisawa T (2018) Midterm results after open versus arthroscopic transosseous repair for foveal tears of the triangular fibrocartilage complex. J Wrist Surg 7(4):292–297CrossRef ABE Y, Fujii K, Fujisawa T (2018) Midterm results after open versus arthroscopic transosseous repair for foveal tears of the triangular fibrocartilage complex. J Wrist Surg 7(4):292–297CrossRef
23.
Zurück zum Zitat Mak MC-K, Ho P-C (2017) Arthroscopic-assisted triangular fibrocartilage complex reconstruction. Hand Clinics 33(4):625–637CrossRef Mak MC-K, Ho P-C (2017) Arthroscopic-assisted triangular fibrocartilage complex reconstruction. Hand Clinics 33(4):625–637CrossRef
24.
Zurück zum Zitat Luchetti R, Atzei A (2017) Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears. J Hand Surg Eur 42(4):346–351CrossRef Luchetti R, Atzei A (2017) Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears. J Hand Surg Eur 42(4):346–351CrossRef
25.
Zurück zum Zitat Nakamura T, Abe K, Nishiwaki M, Iwamoto T, Sato K (2016) Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea. J Hand Surg Eur 42(4):352–356CrossRef Nakamura T, Abe K, Nishiwaki M, Iwamoto T, Sato K (2016) Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea. J Hand Surg Eur 42(4):352–356CrossRef
26.
Zurück zum Zitat Adams BD, Lawler E (2007) Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 9:571–575CrossRef Adams BD, Lawler E (2007) Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 9:571–575CrossRef
Metadaten
Titel
The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal reconstruction using tendon graft
verfasst von
Bo Liu
Margaret Woon Man Fok
Publikationsdatum
22.02.2021
Verlag
Springer Berlin Heidelberg
Erschienen in
International Orthopaedics / Ausgabe 5/2021
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-021-04976-9

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