Arthroscopic Repair of Peripheral TFCC Tears; Long-Term Follow-Up (SS-45)

Abstract

Introduction The purpose of this study is to evaluate long-term follow-up of arthroscopic repair of TFCC tears utilizing the shuttle relay technique. Methods Wrist arthroscopy was performed on all patients using distraction with a wrist arthroscopy tower. Local synovectomy is performed using a 3.0 mm oscillating full radius shaver placed in the 4-5 portal. The shaver is also used to freshen the leading edge of the torn peripheral TFCC. The adjacent edge of the ulnotriquetral ligament can also be freshened using the shaver to improve healing potential. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between flexor carpi ulnaris and extensor carpi ulnaris. The tip of the spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one end of the suture through the peripheral tear and out the 4-5 portal cannula. Braided absorbable suture is employed for the repair. A second spinal needle is then placed in a parallel fashion to the first and the shuttle relay is passed through this needle. The shuttle relay is grasped within the wrist joint and again brought out through the 4-5 portal. The second arm of the suture is passed through the shuttle relay wire loop and percutaneously pulled back through the safe zone along the ulnar aspect of the wrist. This creates a mattress suture repair. The skin bridge between the suture entry points in the safe zone is then divided and gentle spreading of tissue with a hemostat is carried out down to the capsule. The sutures are then tied with the wrist in a pronated position. The patient is then place into a well-molded short arm cast for 6 weeks. Results Evaluation of all 170 patients has been done using the Mayo Modified Wrist Score. These patients have an average score of 95 with a range of 80-100. Complications have included 9 patients with transient numbness along the dorsal cutaneous branch of the ulnar nerve, two patients who required removal of the suture knot from the repair because of local irritation, one late localized wound infection from knot irritation through the skin and two cases of RSD, one that ultimately resolved with long-term hand therapy and a second workers' compensation patient that still complains of ongoing symptoms. Conclusion As is suggested by the average Mayo Modified Wrist Score of 95 these patients have done extremely well. There are several techniques currently being used for repair of peripheral TFCC tears. Several of the orthopaedic equipment companies also make specific kits for repair of TFCC tears. In the era of cost containment, the shuttle relay technique is a viable option that is simple to perform, inexpensive, and allows for excellent results when the surgeon is faced with a patient with a peripheral TFCC tear.