Abstract
Background:Ulnar-sided approach in arthroscopic triangular fibrocartilage complex (TFCC) repair may jeopardize treatment success by exposing the dorsal sensory branch of ulnar nerve (DSBUN) in risk of injury. We aim to conduct a follow-up assessment of arthroscopic outside-in TFCC repair and efficacy of sensory nerve exploration.Methods:We conducted a retrospective chart review of 58 patients (59 wrists) who received arthroscopic repair of the peripheral attachment of the TFCC. Ulnar-sided skin incision and exploration of DSBUN were performed before arthroscopy setting. Arthroscopic outside-in repair through pullout suture ligation was performed. Functional survey at 6 months and 1 year postoperatively was based on Mayo Modified Wrist Score (MMWS), and compared to the preoperative assessment. A p-value of less than 0.05 was considered significant as calculated using paired t-test.Results:Postoperative MMWS averaged 74.32±11.50 at 6 months, and 84.41±9.52 at one year; both showed significant difference as compared to preoperative status. Significant improvement was noted in all 4 individual items except motion retrieval between 6 months and 1 year. Totally, 45 (76%) cases achieved good or excellent results at one year; however, less patients resumed pre-injury activity level when treatment delay was more than 6 months than those treated earlier (41% vs. 57%). Complication included 6 transient paresthesia; 1 anchor migration and 1 distal radioulnar arthrosis. No more nerve complication was found after modification of perineural dissection.Conclusion:Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear. Modified perineural dissection can minimize sensory nerve complications.
Highlights
Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-sided wrist pain and is often associated with decreased grip strength and impaired function [1]
35 out of 59 wrists (59%) showed less than 90% of grip strength compared to the other hand at 1 year
Instead of stripping off the perineural tissue, we explored and isolated dorsal sensory branch of the ulnar nerve (DSBUN) with surrounding vascular cuff preserved to avoid devascularizing the nerve
Summary
Traumatic disruption of the Triangular Fibrocartilage Complex (TFCC) is a common cause of ulnar-sided wrist pain and is often associated with decreased grip strength and impaired function [1]. Arthroscopic repair of peripheral triangular fibrocartilage complex (TFCC) tears is a commonly accepted method [3, 4]. Owing to the anatomical proximity, the dorsal sensory branch of the ulnar nerve (DSBUN) is at risk in setting the 6U wrist arthroscopy portal [5]. Described repairs of the TFCC require subcutaneous suture knots to be used on the ulnar aspect of the wrist to secure the repair [7, 8]. surgeons know the risk and are careful when they set the 6U portal and insert needle for suture passing, DSBUN injuries still occur [9, 10]. Ulnar-sided approach in arthroscopic triangular fibrocartilage complex (TFCC) repair may jeopardize treatment success by exposing the dorsal sensory branch of ulnar nerve (DSBUN) in risk of injury. We aim to conduct a follow-up assessment of arthroscopic outside-in TFCC repair and efficacy of sensory nerve exploration
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