Traumatic Triangular Fibrocartilage Complex Tears Research Articles

The Natural History of Non-operatively Treated Traumatic Triangular Fibrocartilage Complex Tears: A Systematic Review

Abstract Purpose Operative treatment of triangular fibrocartilage complex (TFCC) tears has been well researched; however, data regarding nonoperative management is mixed and scarce. Our review aimed to utilize available data to formulate conclusions regarding treatment algorithms for this heterogeneous injury group. Methods A thorough literature review was performed in Medline (OVID), Embase, Cochrane Library, and PubMed databases with search terms including “triangular fibrocartilage complex” and variations on the full term including “triangular fibrocartilage” or “TFCC,” alongside “non-operative” and “conservative.” Results were then subject to inclusion criteria, ultimately identifying eight studies. Results The studies involved a total of 425 patients and 427 wrists for analysis. The mean age ranged from 30.7 years to 60.4 years. 53.6% of patients were male. The mean follow-up ranged from 12 months to 7 years, with an overall mean follow-up period of 27 months. Primary endpoints focused on various functional outcome scores, range of motion, grip strength, and pain. The nonoperative management of TFCC tears resulted in noninferior and comparable outcomes to operative management. Conclusion Our review identified that the nonoperative management of Palmer-type IB tears with a short period of above-elbow immobilization was an effective treatment option with good functional outcome scores. The nonoperative management of general TFCC tears resulted in comparable functional outcomes when viewed alongside results from other systematic reviews. Risk factors for developing a poor functional outcome or requiring operative management included distal radioulnar joint subluxation, short-arm immobilization, and full tears of the foveal attachment. However, further randomized controlled trials with homogenous data collection are required to make further conclusions regarding the management of this condition.

A structured non-operative treatment program for traumatic triangular fibrocartilage complex tear: A quasi-experimental study

ObjectivesTriangular fibrocartilage complex (TFCC) injury is a common cause of ulnar-sided wrist pain. However, treatment protocols vary across clinical settings and a standardized treatment protocol is needed to improve quality of care.We devised a rehabilitation regime which comprised both orthoses and exercises. We hypothesized that the program can effectively reduce pain and improve functional performance. Materials and methodsThirty-two subjects participated in the 5-phase rehabilitation program. Progress was monitored every 3 weeks. Outcome measures comprised numeric pain rating scale (NPRS), activities of daily living (ADL) pain score, wrist range of motion (ROM), ADL performance score, patient-rated wrist evaluation (PRWE), power grip and distal radioulnar joint (DRUJ) instability grade. ResultsNPRS decreased from 5.3/10 to 0.5/10 while the ADL pain score improved from 10/20 to 19.1/20. ROM in flexion/extension and supination/pronation improved by 35%. Functional performance on ADL performance score and PRWE improved from 21/40 to 38/40 and 49.5/100 to 14.6/100, respectively. Power grip increased by 59.5%, and DRUJ stability improved. DiscussionThe combination of orthoses and progressive strengthening and proprioception training was effective in re-establishing DRUJ stability, and improving wrist strength and functional performance. ConclusionsThis study provided insight for the development of a rehabilitation protocol for patients with TFCC injury.

Arthroscopic foveal repair with suture anchors for traumatic tears of the triangular fibrocartilage complex

BackgroundFoveal tears of the traumatic triangular fibrocartilage complex (TFCC) are the most commonly neglected high-energy injuries of the wrist joint, and the patients with such tears often experience unrecovered ulnar-sided wrist pain and poor wrist function. This study investigated the functional outcomes of patients who underwent arthroscopic repair of foveal TFCC tears with suture anchors and adjuvant platelet-rich plasma (PRP) injections after the surgery.MethodsFrom September 2014 to August 2018, 156 men and 45 women with diagnoses of foveal TFCC tears without wrist fractures underwent arthroscopic repair by using the outside-in method with 1.3-mm suture anchors and subsequent PRP injection. After surgery, splinting was applied for 6 weeks, and the patients underwent rehabilitation, re-examination, and follow-up at our clinic. The patients’ wrist functional scores and grip strength data were retrospectively collected.ResultsThe mean follow-up period was 32.6 months, and the mean age was 26.7 years. The mean modified Mayo wrist score improved from 48.5 ± 2.6 to 82.4 ± 2.5, whereas the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 39.2 ± 6.7 to 10.6 ± 7.5. Overall, the wrist functions of 186 (92.5%) of the patients were satisfactory according to their modified Mayo wrist scores, and the patients with satisfactory scores returned to sports or work activities. These patients retained normal ranges of motion, and their average grip strength in the affected hand was restored to at least 85% of that of the other hand.ConclusionsAccording to the postoperative 25–36 months surgical results of our study, arthroscopic repair with adjuvant PRP injections is a satisfactory method of repairing early foveal tears of the TFCC and can enhance wrist function by relieving pain and increasing tolerance for work or sports.

Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears.

The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis. This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome. In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome. Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J2021;103-B(8):1386-1391.

Traumatic triangular fibrocartilage complex tears: "state of the art" from diagnosis to treatment

Traumatic triangular fibrocartilage complex tears: "state of the art" from diagnosis to treatment

Semiquantitative single-photon-emission computed tomography /computed tomography study to evaluate concomitant ulnar impaction syndrome in patients presenting with triangular fibrocartilage complex tears.

IntroductionPatients presenting with tears of the triangular fibrocartilage complex (TFCC) can have ulnar positive variance, for which the clinical relevance to concomitant ulnar impaction syndrome (UIS) may be unclear. We hypothesized that maximum standardized uptake value (SUVmax), a semiquantitative single-photon-emission computed tomography/computed tomography (SPECT/CT) value, would distinguish between the traumatic TFCC tear and degenerative TFCC tear associated with the UIS. This study aimed to compare SUVmax between patients with TFCC tear only and patients with TFCC tear and UIS.MethodsA total of 26 patients presenting with TFCC tears on magnetic resonance imaging (MRI) underwent semiquantitative SPECT/CT examinations. The diagnosis of concomitant UIS was made based on positive ulnar impaction tests and MRI findings. We compared the SUVmax between patients with and without concomitant UIS. We also calculated the cutoff value for the diagnosis of UIS using receiver operating characteristic curve analysis.ResultsOf 26 patients, 14 had concomitant UIS, and 12 had TFCC tears only. The SUVmax was significantly higher in patients with concomitant UIS than in those without UIS (p = 0.048). With a SUVmax cutoff value of 4.09 for UIS, sensitivity of 67% and specificity of 82% were obtained.ConclusionsIn the semiquantitative SPECT/CT examinations of patients with TFCC tears, those with concomitant UIS had a higher SUVmax than those without UIS. Semiquantitative SPECT/CT can be helpful in confirming concomitant UIS in patients with TFCC tears.

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint

Traumatic triangular fibrocartilage complex (TFCC) injuries require multidisciplinary approach and plan. Trauma to TFCC can lead to instability of the distal radioulnar joint (DRUJ). Injury to TFCC is classified as a stable type that does not cause unstable lesions for DRUJ or unstable type that can cause instability of DRUJ. According to the location and severity of the injury, arthroscopic debridement or arthroscopic repair may be considered. In the ulnar side avulsion of TFCC, which could cause DRUJ instability, arthroscopic examination should be performed to identify an accurate location of the damaged structures, followed by arthroscopic debridement and repair. In the event of TFCC and DRUJ injuries with ulnar positive variance, arthroscopic TFCC repair or ulnar shortening osteotomy after arthroscopic debridement could be considered to solve the instability and ulnar side pain. However, if peripheral TFCC tear with ulnar impaction syndrome and DRUJ instability, it combined operation of ulnar shortening osteotomy and TFCC foveal fixation could be considered. An accurate classification of TFCC and DRUJ injuries is necessary. It is important to resolve and prevent recurrence of ulnar wrist pain caused by instability.

Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures

The purpose of this study was to investigate the effect of untreated triangular fibrocartilage complex (TFCC) tear on the clinical outcome of conservatively treated distal radius fractures. This prospective study comprised 47 consecutive patients who presented at our clinic between January 2009 and January 2010 with displaced radius distal fracture and were treated with closed reduction and casting. During the first 15 days of treatment, all patients underwent wrist MR imaging to detect traumatic TFCC tears. At the final follow-up, all patients were evaluated with Mayo wrist function score and wrist radiographs. Patients were divided into two groups according to presence of TFCC tear, and two groups were analyzed statistically. The mean follow-up period was 38.9 ± 3.5 months (range 36-48). TFCC tear was detected in 24 cases, and remaining 23 cases had no TFCC tear. Both groups were statistically similar regarding age (p = 0.574), gender (p = 0.108), dominant side involvement (p = 0.339), fracture type (p = 0.709) and immobilization period (p = 0.514). According to Mayo wrist score, excellent results were obtained in 21 (44.7%) cases, good in 16 (34.0%) and satisfactory in 10 (21.3%). No significant difference was observed between groups in wrist function scores (p = 0.451). Radiographic measurements were similar between groups (radial length p = 0.835, volar til p = 0.464, radial inclination p = 0.795). Traumatic TFCC tears which are frequently seen together with distal radius fractures do not affect the long-term functional results. Therefore, further diagnostic tests and treatment of TFCC tears in patients with stable distal radius fractures may be unnecessary. However, it should be borne in mind as a reason for continuing wrist pain and instability after distal radius fractures despite proper radiologic recovery.

Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T

PurposeThe purpose of the study was to validate the diagnostic performance of high-resolution isovolumetric magnetic resonance arthrography (MRA) for intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist as compared to conventional MR imaging (MRI). Materials and methodsForty-eight patients with traumatic TFCC tears at arthroscopy were enrolled. All patients had underwent proton-density- and T2-weighted MRI before arthrography and three-dimensional T1 high-resolution isovolumetric examination (3D-THRIVE) MRA on a 3-T MR. We assessed the presence of scapholunate interosseous ligament (SLIL)/lunotriquetral interosseous ligament (LTIL) or TFCC tears using the arthroscopy as a gold standard. ResultsArthroscopy revealed 37 TFCC central tears, 15 TFCC peripheral tears, 20 SLIL tears and 13 LTIL tears. Sensitivities of MRI and MRA were 70.3% and 94.6% for detection of TFCC central tears, 60.0% and 93.3% for detection of TFCC peripheral tears, 65.0% and 85.0% for SLIL tears, and 61.5% and 84.6% for LTIL tears. The specificity of the MRI was 100% for the detection of ligaments and TFCC tears. The specificities of the MRA for detection of TFCC central tears, TFCC peripheral tears, SLIL tears and LTIL tears were 100%, 97%, 96.4% and 100%, respectively. ConclusionIsovolumetric 3D-THRIVE wrist MRA provided better results for depiction of intrinsic ligament and TFCC tears than wrist MRI.

The Natural Course of Traumatic Triangular Fibrocartilage Complex Tears in Distal Radial Fractures: A 13–15 Year Follow-up of Arthroscopically Diagnosed but Untreated Injuries

To evaluate the long-term results of a prospective, longitudinal case series of untreated, traumatic triangular fibrocartilage complex (TFCC) tears found in displaced distal radial fractures. Between 1995 and 1997, 51 patients (24 men, 27 women; age, 20-57 y) with a displaced distal radius fracture had wrist arthroscopy to identify associated injuries. Forty-three patients had complete or partial tears of the TFCC, which were not treated. All patients were contacted in 2010, 13-15 years after the injury. One patient had had a TFCC reattachment due to painful distal radioulnar joint instability and was excluded. Thirty-eight patients returned for a radiographic and clinical follow-up that recorded strength, distal radioulnar joint laxity, range of motion, pain scale score, and subjective and objective outcome scores. After 13-15 years, 17/38 patients were lax in the distal radioulnar joint. The mean grip strength was worse in the patients with a lax distal radioulnar joint (83%, SD 15 of the contralateral side vs 103%, SD 33). The median Gartland and Werley score was 5 (good; range, 0-15) in the lax group compared to 1 (excellent; range, 0-9) in the non-lax group, and the median Disabilities of the Arm, Shoulder, and Hand scores were 14 (range, 0-59) and 5 (range, 0-70) respectively. In this 13-15 year, prospective, longitudinal outcome study of the natural course of TFCC tears associated with distal radius fracture, only 1 patient had been operated on for painful instability since the injury. The subjective and objective results did not provide evidence that a TFCC injury would influence the long-term outcome. However, trends were found and, by speculation, the low number of patients in the series and the risk for a type II error could be the cause of absent statistically significance. Larger, preferably prospective, randomized studies are needed to find out whether a more aggressive treatment is beneficial. Diagnostic I.

VARIOUS PATTERNS OF TRAUMATIC TRIANGULAR FIBROCARTILAGE COMPLEX TEAR

We demonstrate various patterns of traumatic triangular fibrocartilage complex (TFCC) tears including some atypical that cannot be categorized under Palmer's classification. TFCC traumatic tears in 173 wrists were examined arthroscopically or macroscopically and divided into disk tears (subdivided into four types: slit tear, flap tear, horizontal tear and tear within the distal radioulnar joint) and peripheral tears (subdivided into six types: ulnocarpal ligament tear, dorsal tear, radial tear, ulnar styloid tear, foveal tear and distal radioulnar ligament tear). Combinations of these types were found in 32 wrists. Wrist arthroscopy revealed various traumatic TFCC tears that do not come under Palmer's classification; therefore establishment of a new classification for traumatic TFCC tears seems to be warranted.

Revision Wrist Arthroscopy After Failed Primary Arthroscopic Treatment (SS-47)

<h3>Introduction</h3> Arthroscopic treatment of ulnar-sided wrist pain is becoming increasingly prevalent; however, little is known about cases in which primary treatment fails to relieve symptoms. The purpose of this study was to identify common reasons for revision wrist arthroscopy. <h3>Methods</h3> Between March 1997 and July 2010, 23 non-staging revision wrist arthroscopies were performed by the senior author. Twelve patients with intercurrent relief of symptoms or traumatic injury were excluded. One was excluded based on concomitant neuropathy. The remaining eleven patients (5 male and 6 female; mean age 24 years) had symptoms that did not improve with primary arthroscopic treatment, requiring revision wrist arthroscopy at a mean of 14.7 months (4-38 months). Ten patients were originally diagnosed with triangular fibrocartilage complex (TFCC) tears; the remaining patient had no identifiable lesions. Data were collected through retrospective review of intraoperative and clinical findings. <h3>Results</h3> All 11 patients required revision procedures because of persistent wrist pain. In 5 of the 11 patients (45%), distal radial ulnar joint (DRUJ) instability was the major cause for revision. Revisions for all 5 patients revealed TFCC peripheral damage requiring repair (1 revision of an unstable repair, 4 previously treated with only debridement). One patient was lost to follow-up, but all 4 remaining (100%) had complete resolution of pain, regaining normal range of motion (ROM) with DRUJ stability. The chief cause for revision in 5 of the 11 patients (45%) was failure to treat ulnar abutment syndrome (UAS). Initially, 1 of these 5 patients presented with chronic ulnocarpal wrist pain, while 4 of the 5 had presented with pain following injury. These 4 were treated purely as traumatic TFCC tears in prior procedures, with no measures taken to correct ulnar positive variance. Notably, 2 of these patients showed ulnar neutral variance on plain films, but intraoperatively demonstrated lunate cartilaginous damage indicative of dynamic ulnar positive variance. All 5 patients were treated with an arthroscopic wafer ulnar shortening, regaining normal ROM in all cases (100%) and complete relief of pain in 4 (80%). One patient (11%) required revision for a previously undiagnosed scapholunate interosseous ligament (SLIL) tear. This was initially a traumatic case, presenting with ulnocarpal wrist pain that persisted after primary arthroscopic TFCC repair. Revision arthroscopy revealed a Grade-II SLIL tear, which was treated with radiofrequency capsular shrinkage, scaphoid reduction, and percutaneous scaphocapitate pinning. Overall, at an average of 7.3 months follow-up (3-35 months), 10 of 11 wrists (91%) exhibited full ROM, with 8 of the 10 also reporting complete resolution of ulnocarpal wrist pain, as seen in Table 1. <h3>Conclusion</h3> Careful attention to a number of key factors may reduce the incidence of revision arthroscopy. DRUJ instability can be better assessed with arthroscopic-assisted shuck testing, both before and after TFCC repair is performed. A thorough evaluation for UAS—both static and dynamic—in traumatic TFCC tears may reduce the recurrence of pain and revision procedures to address the underlying pathology. Finally, treatment outcomes for traumatic ulnocarpal wrist pain may be improved by identifying concurrent radial-side intercarpal ligament injuries.

Meniscus and discus lesions of triangular fibrocartilage complex (TFCC): treatment by laser-assisted wrist arthroscopy

Meniscus and disc lesions in the triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Characteristic clinical signs are swelling and pain in the distal radioulnar joint (DRUJ) and a 'clicking' noise in the meniscus lesion. If untreated, loss of mobility and grip strength as well as progressive arthritic changes ensue. We investigated in this study the laser-assisted arthroscopic debridement of the central TFCC and meniscus to compare the advantages and disadvantages of such treatment to conventional arthroscopic debridement. Seventy-two patients underwent laser-assisted arthroscopic debridement of traumatic TFCC tears (meniscus and disc). Patients with TFCC tears that were associated with fractures, significant bone or neurovascular pathology or DRUJ instability were excluded from the study. The mean age was 32.4 years; 28 female and 51 male patients were included in the study. The mean follow up was 25.6 months. First of all, we evaluated the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. We then applied the range of motion of the hand (ROM) as second variable during statistical analysis to identify outcome. There were no complications after surgery. No instabilities or dislocations of the DRUJ were noted. The postoperative DASH score indicated that the laser-assisted arthroscopic repair of traumatic peripheral TFCC tears resulted in a very good functional outcome. All patients with isolated meniscus homologue tears were without pain after the operation. At final follow up, the ROM was equal to or greater than that of the contralateral side. We have demonstrated that the TFCC laser debridement technique is easy and safe to perform. The outcome was excellent with less pain and good ROM. In particular, the laser technique enabled a good intra-articular haemostasis and allowed an exact tear debridement.

Clinical Comparison of Arthroscopic Versus Open Repair of Triangular Fibrocartilage Complex Tears

To determine whether traumatic triangular fibrocartilage complex (TFCC) tears treated by arthroscopic repair have improved functional outcome scores, range of motion, grip strength, and pain relief compared with those repaired using an open surgical technique. From 1997 to 2006, 75 patients had repair of traumatic TFCC tears. Thirty-six patients had arthroscopic TFCC repair, and 39 patients had open repair. One patient was lost to follow-up. Evaluation included range of motion, grip strength, preoperative and postoperative Mayo Modified Wrist Score (MMWS), and patient-reported Disabilities of the Arm, Shoulder, and Hand score and visual analog scale score. Data were analyzed using chi-square tests or 2-sample t-tests; significance was set at p < .05. Mean follow-up was 43 months +/- 11. Mean MMWS improved 6.5 points +/- 19.9 after surgery. Fifty-seven percent of patients improved at least 1 level in the MMWS pain score. No statistical difference was found between open and arthroscopic repair in the improvement of MMWS or visual analog scale pain scores. There was increased postoperative nerve pain (ulnar nerve branch) in the open group (14 out of 39 patients) compared with the arthroscopic group (8 out of 36 patients), but this was not found to be statistically significant. Reoperation for distal radioulnar joint instability was performed in 17% of patients. No statistical association was observed between surgery type and the rate of reoperation for instability. Female gender was significantly associated with a higher rate of total reoperation. There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. Although not statistically significant, there was an increased rate of postoperative superficial ulnar nerve pain in the open group (14 out of 39 patients) compared with the arthroscopic group (8 out of 36 patients). After TFCC repair, 13 out of 75 patients required reoperation for distal radioulnar joint instability in this sample. A statistically significant association was found between reoperation rate and female gender.

Arthroscopically Assisted Repair of Peripheral Triangular Fibrocartilage Complex Tears: Factors Affecting Outcome

The purpose of our study was to identify factors affecting the outcome after arthroscopically assisted repair of peripheral triangular fibrocartilage complex (TFCC) tears. Retrospective case series. Thirty-five patients who underwent arthroscopic repair of traumatic TFCC tears were enrolled in this study (mean age, 34 +/- 12 years; 22 female and 13 male patients; mean follow-up, 29 months; range, 6 to 82 months). Patients with TFCC tears associated with distal radius fractures, or significant wrist bone or neurovascular pathology were excluded from the study. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score was used as the primary variable during statistical analysis to identify factors determining outcome. The DASH score in this study was 12 +/- 12 points. A significant correlation was found between the age of the patient and the DASH score, indicating that older age has a significant negative effect on functional outcome. Significant correlations were also found between the DASH score and (1) decreased percentage of grip strength compared with the healthy side, (2) decreased supination, and (3) positive postoperative ulnar variance. Age-related degenerative changes in the wrist might contribute to poor outcome and a TFCC tear resulting from minor or repetitive trauma. Loss of wrist rotation, grip strength, and ulnar positive variance are factors that are correlated with poor outcome. Level IV.

Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair.

Tears in the traumatic triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Tears in the triangular fibrocartilage complex often appear in association with ulnar wrist pain and limited wrist function in work or sport. This study addressed the arthroscopic repair of peripheral tears in the TFCC, in a sample of 37 patients who were undergoing TFCC repair by wrist arthroscopy. From September 1996 to February 1999, 37 patients underwent TFCC repair by wrist arthroscopy. The mean follow-up period was 25.6 months (range, 22-28 months), and the patients' average age was 21 years. The study included 30 men and 7 women. All patients had early peripheral TFCC tears and no wrist fractures. The inside-out method was used to repair the tears and the distal radioulnar joint was fixed for 6 weeks using a 2.0-mm Kirschner wire. After operation, patients were rehabilitated, reexamined, and followed up at the clinic. Complications were also recorded. The results were graded with a Mayo Modified Wrist Score. Ten of the 37 wrists were rated excellent, 24 were good, and 3 were fair. Overall, 34 of 37 patients (92%) rated satisfactorily and returned to sporting or work activities. Four patients experienced mild pain during work or exercise. Although motion remained normal for these patients, grip strength on the affected hand was at least 72% of that on the other hand. Arthroscopic repair of early peripheral tears of the triangular fibrocartilage complex is a satisfactory method of repair. The procedure can enhance patients' wrist function by relieving pain and increasing tolerance for work or sport.

Arthroscopic Capsulodesis of the Lunotriquetral Joint

A case series consisting of 20 consecutive patients with persistent ulnar-sided mechanical wrist pain, lunotriquetral interosseous (LTIOL) ligament tears resulting in joint incongruity and increased laxity, and traumatic triangular fibrocartilage complex (TFCC) tears was reviewed. Each patient underwent an arthroscopic reduction and internal fixation (ARIF) of the lunotriquetral joint, arthroscopic disk-carpal (disklunate-ulnocapitate-disktriquetral, DL-UC-DT) ligament plication, and TFCC repair or débridement. There were 12 right wrists and 8 left wrists, of which 12 were dominant. The mean patient age was 33 years; 7 patients had workers' compensation claims and 2 had legal claims. Fourteen patients recalled a specific injury mechanism, such as hyperextension or rotation. The accompanying traumatic TFCC tears were peripheral in 15 and linear radial in 6 patients (one patient had concomitant peripheral and radial linear tears), and in 6 cases, the palmar ulnocarpal extrinsic ligaments were partially torn. The mean preoperative modified Mayo Wrist Score was 50, and at a mean of 3.1 years after surgery, the score had increased to 88. There were 13 excellent, 5 good, and 2 fair results. Four patients had complications, including transient tenderness along the extensor carpi ulnaris and persistent neuritis of a dorsal branch of the ulnar nerve. Overall wrist comfort and function, as indicated by the modified Mayo Wrist Scores, improved after arthroscopic stabilization of ulnar-sided wrist injuries (pinning of the lunotriquetral joint, disk-carpal ligament plication, and TFCC repair or débridement).

Hemiresection-interposition arthroplasty of the distal radioulnar joint associated with repair of triangular fibrocartilage complex lesions

Sixteen wrists of 15 patients with traumatic triangular fibrocartilage complex tears were treated by hemiresection-interposition arthroplasty of the distal radioulnar joint combined with repair of the torn triangular fibrocartilage complex. The surgical procedure was performed to avoid impingement of the ulnar head against the reconstructed triangular fibrocartilage complex. Most of the wrists showed a positive ulnar variance. The average age of the patients was 39 years. Follow-up averaged 41 months. Complete relief of pain was obtained in 10 wrists. Slight pain persisted in 6 wrists, although it was less than before surgery. The range of motion of the wrist joint and forearm improved postoperatively. Grip strength in all wrists increased. Postoperative complications occurred in 7 wrists of 6 patients: reoperation in 2 wrists, fracture in 1, and tendinitis of the extensor carpi ulnaris in 4. All 15 patients subsequently returned to their previous occupations.