Palmer Type Research Articles

Arthroscopic dual-bone tunnel repair for palmer type IB injuries of the triangular fibrocartilage complex

BackgroundTriangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist.MethodsIn this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery.ResultsThe cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%.ConclusionArthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.

Arthroscopic Treatment of Traumatic Isolated Volar Dislocation of the Distal Radioulnar Joint: Case Report and Management Proposal

Abstract Background Traumatic isolated dislocation of the distal radioulnar joint (DRUJ) has always been an injury recognized for its rarity, misdiagnosis, and possibility of inability to be reduced at emergency care. As a result, little has been discussed so far about the guidelines and routines for its treatment.It is known that some degree of injury to the triangular fibrocartilage (TFC) is required for a DRUJ to be dislocated. However, there is no evidence to prove that this injury will cause any degree of DRUJ instability following reduction. Methods We show a case of a patient with traumatic isolated volar dislocation of the DRUJ in which, after failure in the attempt to reduce it in the emergency room, surgical treatment was performed using an arthroscopic method. Results Computed tomography and magnetic resonance imaging axial sections showed the impaction of the distal ulna, with its groove to the extensor carpi ulnaris tendon blocked in the anterior labrum of the sigmoid notch of the radius. Arthroscopy before reduction showed that the distal portion of the TFC was intact, with damage to the foveal insertion (Palmer Type 1B, Atzei Class 3). After joint reduction, a loop-shaped repair of the TFC foveal lesion was performed through the central disc and attached to the distal ulna footprint. The patient presented good progression, with quick recovery, and no serious complications or the need for a second surery. Conclusion We indicate the use of arthroscopy in patients with irreducible isolated volar dislocation, with subacute or chronic presentation, who have to be managed in the operating room. It is a useful method for diagnosing and repairing the TFC injury. This will prevent possible complications and provide faster recovery, mainly reducing the time of immobilization.

A new arthroscopic repair technique for triangular fibrocartilage complex using an intracapsular suture: an outside-in transfer all-inside repair

BackgroundArthroscopic repair is a promising, minimally invasive surgical technique for patients with Palmer type 1B peripheral triangular fibrocartilage complex (TFCC) tears. Although several arthroscopic techniques are effective for repairing Palmer type 1B TFCC tears, some shortcomings remain. So, we report an arthroscopic repair technique for the treatment of Palmer type 1B Atzei class 1 TFCC tears using an intracapsular suture: an outside-in transfer all-inside repair.MethodsA retrospective analysis of 38 Palmer type 1B TFCC injury patients admitted to our hospital were randomly divided into 2 groups. The group A was sutured from the outside to the inside, with a total of 21 cases; the group B was sutured with the new arthroscopic repair technique, with a total of 17 cases. Observe and compare the VAS scores and modified Mayo wrist function scores of all patients before 3, and 6 months after the operation and evaluate the incidence of thread knots in patients with different treatment methods. The methodology was performed an arthroscopic intracapsular suture using an outside-in transfer, all-inside repair technique, which is a modified method of the outside-in and all-inside technique using the needle of a 10-mL sterile syringe, for Palmer type 1B TFCC tears. A No. 2 polydioxanone suture was threaded through the needle and entered the wrist joint. Next, the needle was withdrawn carefully along the suture to the proximal tear ulnar surface of the TFCC and penetrated the TFCC, exiting the articular cavity surface of the ulnar side of the torn TFCC. Finally, arthroscopic knotting was performed.ResultsThis new treatment was as effective as the previously arthroscopic techniques and had the advantages of no additional incision and decreased risk of operation-related complications. The incidence of thread knots in the group A (28.57%) was significantly higher than that in the group B (0%), and the difference was statistically significant (P = 0.024). There was no significant difference in VAS score and modified Mayo wrist function scores between the two groups (P > 0.05).ConclusionsThe outside-in transfer, the all-inside repair technique is suitable for Palmer type 1B Atzei class 1 TFCC tears. We recommend this technique as a useful alternative to the conventional methods of repairing Palmer type 1B TFCC tears.

Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy.

The triangular fibrocartilage complex (TFCC) is essential for maintaining wrist stability. Injury-caused pain is the primary cause of ulnar wrist pain. The TFCC injury refractory to conservative treatment requires further surgical treatment, and because Palmer type IB tears belong to peripheral injuries due to their proximity to the blood supply area, arthroscopic suture repair has become the preferred surgical method for TFCC injury repair, exhibiting strong healing ability. This study reviewed the anatomy of TFCC, injury classification, and advances in arthroscopic suturing for treating Palmer type IB.

Outcomes of surgical management of Palmer type IB triangular fibrocartilage complex injuries

Palmer type IB triangular fibrocartilage complex (TFCC) is one of the most common causes of ulnar wrist pain. The primary surgical treatment for these lesions is open and wrist arthroscopic technique to repair TFCC. This study was carried out to describe the result of both techniques in the treatment of type IB TFCC injuries. A retrospective study was carried out on 18 patients with surgical treatment at the Hospital of Traumatology and Orthopaedics of Ho Chi Minh City from 2019 to 2021. Results showed that there were 13 female patients with a mean age of 34.8±8.1 years old, and 5 male patients with a mean age of 19.4±2.3 years old. Of which, 10 patients underwent arthroscopic surgery, accounting for 55.6%, and 8 underwent open surgery, accounting for 44.4%. The mean follow-up time of the arthroscopic group was 17.6±9.7 months, and in the open surgery group was 18.8±4.6 months. The mean visual analog scale (VAS) score in the arthroscopic group was 1.3±1.8, and in the open surgery group was 0.62±0.74 at the time of final follow-up. The arthroscopic group had an average score of 83±15.1, and the open surgery group was 88.1±8.4 on the Mayo modified wrist score (p&gt;0.05). In all cases, there were 8 excellent cases, 6 good cases, 3 satisfactory cases and 1 poor case. The common complications in the arthroscopic group were ulnar nerve injuries in 2 cases and a prominent suture knot in 2 cases, followed by extensor carpi ulnar tendonitis in 1 case. In the open surgery group, there were 2 cases of prominent suture knots and 1 case of pin infection. In conclusion, both techniques of treating Palmer IB TFCC injuries gave similar good results, the choice of method depends on the surgeon’s reference. However, the risk of ulnar nerve injury was higher in the arthroscopic group.

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies.

Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears. A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair. A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair. These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique.

Ultrasound With Artificial Intelligence Models Predicted Palmer 1B Triangular Fibrocartilage Complex Injuries

To calculate the diagnostic accuracy from the confusion matrix using deep learning (DL) on ultrasound (US) images of Palmer 1B triangular fibrocartilage complex (TFCC) injury. Twenty-nine wrists of 15 healthy volunteers (11 men; mean age, 34.9 years ± 9.7) (control group) and 20 wrists of 17 patients (11 men; mean age 41.0 years ± 12.2) with TFCC injury (Palmer type IB) (injury group) were included in the study. The diagnosis of Palmer 1B TFCC injury was made using magnetic resonance imaging, computed tomography arthrography, and intraoperative arthroscopic findings. In total, 2,000 images were provided to each group, 80% of which were randomly selected by AI and used as training data; the remaining data were used as test data. Transfer learning was conducted using a pretrained 3 separate models (GoogLeNet, ResNet50, ResNet101). Model evaluation was performed using a confusion matrix. The area under a receiver operating characteristic curve was also calculated. The occlusion sensitivity was used to visualize the important features. For the prediction of TFCC injury by the DL model, the best score of accuracy was 0.85 in GoogLeNet, a recall was 1.0 in ResNet50 and ResNet101, and a specificity was 0.78 in GoogLeNet. In predicting the TFCC injury for the test data, the best score of the AUC was 0.97 on ResNet101. Visualization of important features showed that AI predicted the presence of injury by focusing on the morphology of the articular disc. US images using the DL model predicted Palmer 1B TFCC injury with high accuracy, with the best scores of 0.85 for accuracy on GoogLeNet, 1.00 for sensitivity on ResNet50 and ResNet101, and 0.78 for specificity on GoogLeNet. The use of DL for US imaging of Palmer 1B TFCC injury predicted the injury as well as magnetic resonance imaging and computed tomography arthrography LEVEL OF EVIDENCE: IV; retrospective case series study.

Motion Analysis of Triangular Fibrocartilage Complex by Using Ultrasonography Images: Preliminary Analysis.

The triangular fibrocartilage complex (TFCC) is a significant stabilizer of the distal radioulnar joint. Diagnosing TFCC injury is currently difficult, but ultrasonography (US) has emerged as a low-cost, minimally invasive diagnostic tool. We aimed to quantitatively analyze TFCC by performing motion analysis by using US. Twelve healthy volunteers, comprising 24 wrists (control group), and 15 patients with TFCC Palmer type 1B injuries (injury group) participated. The US transducer was positioned between the ulnar styloid process and triquetrum and was tilted ulnarly 30° from the vertical line. The wrist was then actively moved from 10° of radial deviation to 20° of ulnar deviation in a 60-rounds-per-minute rhythm that was paced by a metronome. The articular disc displacement velocity magnitude was analyzed by using particle image velocimetry fluid measurement software. The mean area of the articular discs was larger on ulnar deviation in the control group. The mean articular disc area on radial deviation was larger in the injury group. The average articular disc velocity magnitude for the injury group was significantly higher than that for the control group. The results suggest that patients with TFCC injury lose articular disc cushioning and static stability, and subsequent abnormal motion can be analyzed by using US.

Long-term outcome after arthroscopic debridement of Palmer type 2C central degenerative lesions of the triangular fibrocartilage complex.

The purpose of this study was to report long-term objective and patient-reported outcome after arthroscopic debridement of central degenerative triangular fibrocartilage complex (TFCC) lesions. A total of 17 patients with central degenerative TFCC (Palmer type 2C) lesions and ulnar positive variance who were treated by arthroscopic debridement were retrospectively reviewed. Mean follow-up was 8.8years. Assessment facilitating the Modified Mayo Wrist score (MMWS), the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH score), recording of pain level and of patient satisfaction, and radiological examination were done. Patients reached a pain level of 1.7 VAS, MMW score of 92, and DASH score of 22. No significant differences could be detected between the operated and the contralateral extremity regarding range of motion and grip strength for all patients. No perioperative complications occurred. Arthroscopic debridement of central degenerative TFCC lesions is safe, reliable, and efficacious even for ulnar positive variance. Therapeutic IV.

Early result of arthroscopic repair of Palmer type I-B triangular fibrocartilage complex (TFCC) tears

Early result of arthroscopic repair of Palmer type I-B triangular fibrocartilage complex (TFCC) tears

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

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.

Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair.

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20-64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3-10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

II.

Diagnosis and treatment of Palmer type IB TFCC injury using wrist arthroscopy

Objective To evaluate the value of wrist arthroscopy in the diagnosis and treatment of Palmer type ⅠB TFCC injuries. Methods Thirty-two cases of TFCC injury (Palmer type ⅠB) that were diagnosed and treated with wrist arthroscopy between January 2013 and February 2015 were analyzed retrospectively. According to Palmer classification, 10 cases had accompanying ulnar styloid fracture, 5 cases had accompanying type ⅡA injury, 8 cases had accompanying type ⅡB injury, and 6 cases had accompanying type ⅡC injury. For cases without accompanying type Ⅱ injury, endoscopic repair of ulnar joint capsule (outside-in or in-outside suturing) was performed. Chondroplasty was carried out in cases with accompanying type ⅡB injury, while arthroscopic debridement, chondroplasty and ulnar head Wafer excision were done in cases with accompanying type ⅡC injury. Preoperative and postoperative assessments included visual analog pain scores (VAS), grip strength, range of motion, and modified Mayo wrist score. Results All the patients were follow-up with a mean time of 13.4 months. There were no complications. Significant wrist pain relief was achieved, with VAS score reducing from (6.0±2.3) points preoperatively to (1.0±1.1) points one year postoperatively. Grip strength increased from preoperative (60.3±4.3)% of the contralateral side to (82.0±4.1)% one year postoperatively. Wrist range of motion changed from (62.0±4.3)° to (105.0±4.3)° for flexion/extension and from (125.0±16.0)° to (152.0±18.0)° for pronation/supination. The outcomes were rated as excellent in 26 cases, good in 3 cases, and fair in 3 cases by modified Mayo wrist score, with an excellent rate of 90.6%. Conclusion Wrist arthroscopic diagnosis and treatment of Palmer type ⅠB TFCC injury is safe and effective. Key words: Wrist; Arthroscopes; Triangular fibrocartilage complex

Functionality After Arthroscopic Debridement of Central Triangular Fibrocartilage Tears With Central Perforations

To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length. Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement. Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar-sided wrist pain after debridement who had preoperative static positive ulnar variance of 1.8 mm or more may be treated by ulnar shortening earlier in order to spare them prolonged symptoms. Therapeutic IV.

La prise en charge des lésions du TFCC chez les adolescents par arthroscopie et mini voie d’abord

Purpose Post-traumatic injury of the triangular fibrocartilagineus complex (TFCC) can result in debilitating wrist problems. Although diagnosis and treatment of these lesions is well described for the adult population, hardly any data exists for this type of injury in young adolescents. Methods Between 2011 and 2014 seven patients between 10 and 14 years of age have consulted our department for posttraumatic ulnar-sided wrist pain. Previous trauma included distal radial fractures with a concomitant fracture of the ulnar styloid, multiple micro-traumas of the wrist and an overuse injury. Clinical evaluation showed tenderness over the TFCC complex, pain on movement and in most cases instability of the distal radio-ulnar joint (DRUJ) with episodes of sub/dislocation in two patients. Pre-operative arthro-MRIs were conducted confirming the pathology in only 3 cases. Therefore, all patients underwent diagnostic arthroscopy of the wrist followed by surgical treatment according to the discovered lesion. The mean age at the time of surgery was 12.9 years. Results Arthroscopy of the wrist confirmed a TFCC lesion in all patients. In 5 cases the injury was classified as Palmer type 1B, once as a combined type 1A/1B and once as type 1A. All 6 patients with a type 1B injury underwent arthroscopically assisted mini-open reconstruction of the TFCC. Treatment of the type 1A injury consisted of arthroscopic shaving of the central lesion. Postoperative clinical examination revealed stable wrists with a normal range of motion in all cases. Patients reported a decrease in pain-level during daily activities or were entirely pain-free. Conclusion TFCC lesions in the adolescent population are difficult to evaluate on an arthro-MRI and results are often inconclusive. Diagnostic arthroscopy is thus the preferred method of diagnosis for this type of injury. The arthroscopic assisted mini-open TFCC reconstruction is a reliable technique to achieve DRUJ stability and good clinical outcomes.

Results of arthroscopic repair of triangular fibrocartilage complex peripheral tears (Palmer type 1B)

Triangular fibrocartilage complex (TFCC) injury is the major cause of wrist pain on the ulnar side. In this study, treatment outcomes of arthroscopically repaired peripheral TFCC tears (Palmer type 1B) were evaluated retrospectively. Thirty-eight patients (30 males, 8 females; mean age 27.6; range 19 to 42 years) with TFCC tears (Palmer type 1B) who were treated arthroscopically between February 2007-July 2012 were evaluated retrospectively. The data were collected by Mayo wrist evaluation form and by preoperative and postoperative visual analogue scale (VAS). The results of the data collected by the Mayo wrist evaluation forms were perfect in 30 patients and good in 8 patients. Preoperative VAS was 6.53 (range: 4.5-8.2) and postoperative VAS was 1.48 (range: 0.3-3.1). With the arthroscopic technique, TFCC tears can be repaired with minimal harm and better visualization, and evaluation of all the structures of the wrist can be done. Outside-to-inside suturing technique, which is performed through the portal opened 1 cm inferior to the 6R portal, is the least traumatic technique and does not carry the risk of injury to the superficial branch of the ulnar nerve. With this technique, the complaints of preoperative pain can be eliminated significantly.

Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint

The purpose of this study was to determine functional and subjective results of patients who received arthroscopic debridement for their TFCC Palmer 1B lesions and to compare their results with those of arthroscopic suture repair. Between March 2007 and August 2011, 36 patients were diagnosed with Palmer type 1B tears and underwent arthroscopic debridement. 31 patients (15 males and 16 females) were followed up for an average of 26.7 months (±17.4 months) postoperatively. Their average age was 36.7 years (±12.7 years). Follow-up included the determination of range of motion (ROM), grip strength, pain, and wrist scores (modified Mayo wrist score (MMWS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)). Postoperative ROM averaged 99.2 % for the extension/flexion arc, 95.5 % for the radial/ulnar deviation arc, and 99.4 % for the pronation/supination arc of motion when compared with the contralateral wrist. The MMWS was rated excellent in 48 % of patients, good in 39 %, fair in 13 %, and poor in 0 %. The average DASH score was 17.02 (±14.92). There was a significant reduction in pain. The grip strength was 96.7 % (±15.8), pulp-to-pulp pinch 101.9 % (±17.4), and the ulnar variance -0.12 ± 1.69 mm. Arthroscopic debridement of Palmer type 1B lesions in stable DRUJ yields satisfactory to excellent results. Our study showed similar results compared with the studies of arthroscopic suture repair with shorter postoperative care and fewer complications.

Arthroscopic Repair of Ulnar-Sided Triangular Fibrocartilage Complex (Palmer Type 1B) Tears: A Comparison Between Short- and Midterm Results

To compare short- and midterm functional and subjective outcomes of arthroscopically repaired Palmer 1B tears. At 2 time points, we evaluated 49 patients with Palmer 1B tears who underwent arthroscopic repair. We examined 46 patients (23 males and 23 females) in the short-term at an average of 11 months (range, 6-23 mo) postoperatively. In a second midterm follow-up, we examined 40 patients (20 males and 20 females) an average of 4.8 years (range, 4.2-5.9 y) after repair. Between short- and midterm follow-ups, 6 patients underwent an ulnar-shortening osteotomy to alleviate persistent ulnar-sided symptoms. Objective and subjective evaluation included the determination of range of motion, grip strength, pain, and wrist scores (modified Mayo wrist score and Disabilities of Arm, Shoulder, and Hand score). Compared with short-term repair results, midterm outcomes showed a further improvement in pain, wrist scores, grip strength, and motion. Neither static nor dynamic ulnar variance was correlated to preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand scores, short-term modified Mayo wrist scores, or need for ulnar-shortening osteotomy. Five patients improved only after having received an ulnar shortening osteotomy. After repair of Palmer 1B lesions, patients continued to improve in function and comfort at least into the second year, although some needed to have the ulna shortened to achieve this result.

Early results with arthroscopic repair of peripheral tears of the triangular fibrocartilage complex (Palmer Type 1B)

Early results with arthroscopic repair of peripheral tears of the triangular fibrocartilage complex (Palmer Type 1B)