Triangular Fibrocartilage Complex Research Articles

Fiber anatomy and histological characteristics of the innervation of the triangular fibrocartilage complex.

To evaluate the precise origin of sensory nerves through gross anatomical study of the TFCC, synthesized alongside imaging and histological techniques. Six cadaveric forearm specimens were obtained to map the course and branches of the ulnar nerve through macrodissection. Immunohistochemical staining targeting PGP 9.5 and type IV collagen was performed on frozen TFCC sections to visualize nerve fibers microscopically. Computed tomography, magnetic resonance imaging, and arthrography findings were also reviewed. At the macroscopic level, the articular branches supplying the TFCC originated predominantly from the dorsal branch of the ulnar nerve. Microscopic analysis revealed positive PGP 9.5 expression and discernible neural marker expression, signifying fine nerve fiber ingrowth within the TFCC. Imaging modalities aided the diagnosis of TFCC lesions. The dorsal cutaneous branch of the ulnar nerve, medial cutaneous nerve of the forearm, and volar sensory branch of the ulnar nerve emerged as the principal nerves innervating the TFCC. This study provides anatomical evidence that the TFCC receives innervation from branches of the ulnar nerve and contains sensory nerve fibers. These findings enhance understanding of potential neuropathic pain mechanisms in TFCC injuries and offer insights to guide surgical interventions. Further investigations are warranted to elucidate the clinical implications.

Pathophysiology of longitudinal forearm instability (Essex-Lopresti syndrome) and implications for treatment.

Longitudinal forearm instability, or Essex-Lopresti syndrome, associates radial head fracture and rupture of the structures uniting the 2 bones, mainly the interosseous membrane and triangular fibrocartilage complex adjacent to the distal radioulnar joint. It is often overlooked at first, and should be screened for in case of comminuted radial head fracture without elbow dislocation or instability. Treatment should be prompt, within 4 weeks of trauma, to avoid soft-tissue retraction and hopefully allow healing. This interval is anecdotal, without firm evidence, but matches observations regularly reported in the literature [1]. In the acute phase, treatment consists in rigid, usually unipolar, radial head replacement, protected healing of the interosseous membrane by a TightRope suture button between the bones, radioulnar pinning and triangular fibrocartilage complex suture, followed by 6 weeks' immobilization. Progression is usually favorable. Chronic forms, beyond 4 weeks, when soft-tissue healing is impossible, require interosseous membrane reconstruction. In case of radiocarpal impingement due to ascension of the radius, ulnar shortening osteotomy must be associated. Medium-term results in such cases are much less certain. As a last resort, the "one-bone forearm" is a solution.

Semiconstrained Distal Radioulnar Joint Arthroplasty: Functional Outcomes and Complications

Abstract Background: The semiconstrained distal radioulnar joint (DRUJ) prosthesis (Aptis Medical, Louisville, KY) is an option in the treatment of refractory DRUJ pathology that has shown promising results. Purpose: This study aims to evaluate the short- to midterm functional outcomes, complications, and factors affecting outcomes of semiconstrained DRUJ arthroplasty. Methods: We retrospectively reviewed 47 DRUJ arthroplasty procedures (on 46 consecutive patients) from a single surgeon between 2010 and 2022. Demographic data, range of motion, grip strength, and patient-reported outcome measures (PROMs: Quick Disability of the Arm, Shoulder, and Hand; Patient-Rated Wrist Evaluation; modified Mayo Wrist Score [mMWS]; and visual analog scale [VAS] for pain) were collected. Complications were classified as major (requiring surgery) or minor (treated conservatively). Results: The average follow-up was 3.37 years (standard deviation, 3.51; range, 0.04–15.62 years). A total of 30% of patients (n = 14) were followed for more than 5 years. Postoperatively, supination significantly increased and VAS pain scores improved significantly. Patients also experienced improved function in the operative wrist as assessed by the mMWS. Patients with prior DRUJ and/or triangular fibrocartilage complex surgery were more likely to have additional diagnoses at the time of definitive surgery and our postoperative outcomes varied based on prior surgery and additional diagnoses, with a trend toward higher pain levels and worse PROMs. The overall complication rate was 17%, with one major complication consisting of a posttraumatic periprosthetic ulna fracture. All other complications were minor. Implant survival was 100%. Conclusion: Semiconstrained DRUJ arthroplasty significantly improves pain levels and functional outcomes at short- to midterm follow-up. Patients who had undergone previous related surgeries were showed a trend toward higher postoperative pain levels and worse PROMs. Although complications were common, overall patient satisfaction and implant survivorship were high. Level of Evidence: IV

The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report.

The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling. A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. The diagnosis was confirmed as chronic DRUJ instability. The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.

Effectiveness of Platelet-rich Plasma Injection as an Adjunct Treatment to Arthroscopy for TFCC Injury: A Retrospective Cohort Study.

Triangular fibrocartilage complex (TFCC) injuries can cause significant patient dysfunction. Platelet-rich plasma (PRP) has emerged as a potential adjunctive treatment for arthroscopic TFCC repair, with some studies suggesting improved outcomes. This study aims to evaluate and compare PRP as an adjunctive treatment in arthroscopic TFCC tear repair. This retrospective cohort study examined patients undergoing arthroscopic TFCC repair at Institut de la Main, Paris, France (December 2021-2022). Patients were split into two groups: arthroscopic repair alone (1) and repair with PRP injections (2). Physical examinations were conducted pre- and posttreatment, recording flexion, extension, and radial/ulnar deviation of the affected and contralateral wrists. A total of 33 patients (20 men and 13 women) with a mean age of 30.55 ± 9.17 years were included. PRP injections were given to 16 patients with arthroscopic TFCC repair; 17 had repair only. No significant differences existed preoperatively between groups in wrist function or pain (P > 0.05). The Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score differed significantly (P = 0.004). The non-PRP group demonstrated better postoperative upper extremity function, with a mean Quick DASH score of 7.75 ± 5.91 compared with 12.64 ± 6.79 in the PRP group. No significant difference between groups was observed in the pain visual analog scale (P > 0.05). PRP injections with TFCC repair did not improve function over repair alone. The non-PRP group showed better function (lower Quick DASH scores). Pain reduction was similar between groups. Larger trials and cost-effectiveness studies are needed to fully assess PRP's benefits in TFCC repair.

Incidental Triangular Fibrocartilage Complex Changes on Wrist MRI.

Triangular fibrocartilage complex (TFCC) changes on wrist magnetic resonance imaging (MRI) may occur in patients without corresponding symptoms and examination consistent with TFCC pathology. This study aims to define the rate of asymptomatic TFCC changes in patients undergoing wrist MRI for indications other than ulnar-sided wrist pain and to compare this with the rate in ulnar-sided wrist pain patients. Patients who underwent wrist MRI at a single large orthopedic practice over a 2-year period were identified by Current Procedural Terminology (CPT) code 73221. Patients with an associated diagnosis, including "hand," "wrist," "radius," "radial," "scaphoid," "navicular," or "De Quervain," were retrospectively reviewed for demographics, symptoms, examination, trauma, and MRI findings. Patients with ulnar-sided wrist pain were used as the comparison group. Wrist MRIs were available for 132 patients, with 92 in the primary cohort and 40 forming the comparison group. The MRI indications included wrist pain (other than ulnar-sided; 64%), hand/thumb pain (21%), mass (12%), and numbness/tingling (2%). The TFCC MRI changes were seen in 44% of the patients and abnormal TFCC was positively associated with age. In contrast, 80% of the 40 patients with ulnar-sided wrist pain had abnormal TFCC on MRI. There is a high rate of abnormal TFCC identified on MRI in patients without corresponding ulnar-sided wrist symptoms. This highlights the importance of not treating MRI imaging in isolation without correlating with the patient's symptoms while also preparing patients for a high likelihood of asymptomatic TFCC changes on routine wrist MRI. Retrospective case series; Level IV.

Is the ulnar fovea sign positive only in foveal tears of the triangular fibrocartilage complex?

A positive ulnar fovea sign is usually considered to be specific for foveal disruption of the distal radioulnar ligaments. A retrospective review was done of 73 patients with a positive ulnar fovea sign. Only 21 patients had a foveal tear on arthroscopic examination.Level of evidence: IV.

Ulnar variance in MRI: Relations with triangular fibrocartilage complex thickness and angle in Saudi population

BackgroundEvaluating ulnar variance (UV) and triangular fibrocartilage complex (TFCC) is crucial since they might have dual effects on the wrist structure and function. This study aims to assess some anthropometric measurements of the wrists of the Saudi population using MRI. Materials and methodsA cross-sectional retrospective study was conducted on 64 wrist normal MR images. Sociodemographic characteristics were retrieved and kept confidential. Image analysis was performed on Digital Imaging and Communications in Medicine files. UV and TFCC thickness and angle were measured in the same slice. Statistical analysis was conducted, and a significance <0.05 was considered. ResultsThe ages of the selected sample ranged from 18 to 67 years; 45 were males, and 19 were females with 32 right and 32 left wrists. The cases showed 59.4 % negative UV and 40.6 % positive UV (mean ± SD of −2.24 ± 0.55 and 1.59 ± 0.48). TFCC thickness mean ± SD of 2.34 ± 0.61, and its angle mean ± SD of 32.39 ± 4.68. Significant differences were elaborated between the positive and negative UV population in the means of UV, TFCC thickness, and angle (p < 0.001). Also, age-dependent significant differences were detected in the UV value and TFCC thickness (p = 0.042 and 0.013). Correlation and linear regression showed substantial relations between UV and TFCC thickness and angle. Also, TFCC thickness with the angle. ConclusionThis study provided a valuable guide for evaluating and managing wrist problems in Saudis and primary data for further investigations.

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.

Robot-assisted transosseous repair of triangular fibrocartilage complex: a cadaver study.

The feasibility and accuracy of robot-assisted bone tunnel construction in the transosseous repair of the triangular fibrocartilaginous complex (TFCC) were compared with those of freehand arthroscopic repair. A total of 20 cadaveric specimens were randomized into robotic-assisted and arthroscopy-guided groups. Three bone tunnels were constructed in the ulnar foveal region in each specimen. The discrepancy between the planned and actual tunnel exits was determined in the robot-assisted group by merging images. The success rate of tunnel construction, time consumption and number of drilling attempts were compared between groups. The median planned/actual exit discrepancy was 0.8 mm in the robot-assisted group, with 90% of tunnel exits successfully placed in the footprint region, compared to 63.3% in the arthroscopy-guided group. The robot-assisted group spent less time and required fewer drilling attempts to construct bone tunnels. These results indicated that the robot-assisted technique can accurately construct multiple bone tunnels in the foveal region and reduce the difficulty of TFCC transosseous repair.Level of evidence: III.

Comparative study of short-term effectiveness of three surgical methods for ulnar styloid base fracture complicated with triangular fibrocartilage complex injury

To compare the short-term effectiveness of arthroscopic suture of triangular fibrocartilage complex (TFCC), arthroscopic suture of TFCC combined with open reduction and internal fixation, and simple open reduction and internal fixation in the treatment of distal radius fractures combined with ulnar styloid base fractures and TFCC injury. A clinical data of 97 patients with distal radius fractures combined with ulnar styloid base fracture and TFCC injury, who were admitted between September 2019 and September 2022 and met the selective criteria, was retrospectively analyzed. After reduction and internal fixation of distal radius fractures, 37 cases underwent arthroscopic suture of TFCC (TFCC group), 31 cases underwent arthroscopic suture of TFCC combined with open reduction and internal fixation of ulnar styloid base fractures (combination group), and 29 cases underwent simple open reduction and internal fixation of ulnar styloid base fractures (internal fixation group). There was no significant difference in baseline data between groups ( P>0.05), such as gender, age, injury side, time from injury to operation, and preoperative radius height, palm inclination, ulnar deviation, grip strength, wrist range of motion (ROM) in rotation, ulnar-radial deviation, and flexion-extension. The differences (change value) in radius height, metacarpal inclination angle, ulnar deviation angle, grip strength, and wrist ROM in rotation, ulnar-radial deviation, and flexion-extension between preoperative and 12 months after operation in 3 groups were compared. The effectiveness was evaluated according to the modified Gartland-Werley score at 12 months after operation. All incisions healed by first intention. All patients were followed up 12-18 months (mean, 14 months). X-ray films showed that there were 4 patients with non-union of ulnar styloid base fracture in TFCC group, and the remaining patients had fracture healing at 3 months after operation. The radius height, palm inclination, and ulnar deviation of 3 groups at 12 months after operation were significantly better than those before operation ( P<0.05); however, the differences in the change values of the above indexes between groups was not significant ( P>0.05). At 12 months after operation, the change values of wrist ROM in rotation, ulnar-radial deviation, and flexion-extension in the TFCC group and the combination group were significantly greater than those in the internal fixation group ( P<0.05), and there was no significant difference between the TFCC group and the combination group ( P>0.05). The change values of grip strength was significantly greater in the combination group than in the internal fixation group ( P<0.05); there was no significant difference between the other groups ( P>0.05). The excellent and good rates according to the modified Gartland-Werley score were 91.89% (34/37), 93.54% (29/31), and 72.41% (21/29) in the TFCC group, the combination group, and the internal fixation group, respectively. The excellent and good rates of the TFCC group and the combination group were significantly higher than that of the internal fixation group ( P<0.05); there was no significant difference between the TFCC group and the combination group ( P>0.05). For ulnar styloid base fractures with TFCC injury, compared with simple open reduction and internal fixation, arthroscopic suture of TFCC or suture TFCC combined with internal fixation treatment are both beneficial for wrist function recovery, and their short-term effectiveness are similar. Therefore, arthroscopic suture of TFCC may be a better choice.

Reliability of Wrist Arthroscopy in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Tears

Wrist arthroscopy is considered the gold standard for diagnosis of intra-articular wrist conditions including triangular fibrocartilage complex (TFCC) tears; however, the ability to reliably diagnose TFCC pathology during wrist arthroscopy is unclear. The purpose of this study was to assess the reliability of the diagnosis of TFCC tears on wrist arthroscopy videos. Five hand surgeons reviewed 43 cases on a secure web-based platform at two time points separated by 4-6 weeks. Each case included a deidentified clinical vignette and wrist radiographs with ulnar variance measurements and an arthroscopy video of ulnar wrist pathology, averaging 42 seconds. Surgeons were queried on the presence of TFCC tear and Palmer and Atzei classifications. Interobserver/intraobserver reliabilities were determined using kappa coefficients. The interobserver reliability regarding the presence/absence of TFCC tear was fair-good, with kappa coefficients of 0.596 in the first round of case review and 0.708 in the second round. The overall intraobserver reliability for the presence/absence of TFCC tear was also fair-good, with a kappa coefficient of 0.567. For cases with central TFCC tears, the interobserver reliability regarding the presence of TFCC tear was perfect, with a kappa coefficient of 1.0. When central tears were excluded, the kappa coefficients decreased to 0.322 and 0.368 in each round. The interobserver reliability for the Palmer and Atzei classifications was low, with kappa coefficients of 0.220 and 0.121 in the first round and 0.222 and 0.123 in the second round. Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of TFCC tear on wrist arthroscopy. However, when central TFCC tears were excluded, interobserver reliability was poor. These findings demonstrate a need for a focus on education for wrist arthroscopy anatomy. This investigation demonstrated poor agreement in surgeon identification and classification of TFCC tears, aside from central TFCC tears. The low reliability has a direct bearing on treatment considerations for TFCC tears.

Role of Vickers Ligament in the Pathogenesis of Madelung Deformity.

The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius, leading to Madelung deformity. The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament. All 22 patients (33 wrists) with Madelung deformities treated surgically between 2018 and 2022 were included. The diagnosis was confirmed radiographically in all patients. The three-dimensional computed tomography (3D-CT) data of 16 patients (19 wrists) were available. Magnetic resonance imaging (MRI) data were available for 9 patients (14 wrists). Wrist arthroscopy was used in 4 patients. The Vickers ligament was resected and submitted for histopathological examination in 8 patients. Radiographic outcomes, 3D-CT, MRI, arthroscopy, surgical findings, and histopathology of the Vickers ligament were evaluated. The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius. In the sequential MR coronal images, the Vickers ligament could be divided into 3 branches, extending to the lunate, triquetrum and ulnar styloid. Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist. The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex (TFCC). The Vickers ligament is not a separate aberrant ligament. The nature of the Vickers ligament is a combination of the stretched TFCC ligament (palmar radioulnar ligament, ulnotriquetral ligament and ulnolunate ligament) and radiolunate ligament. The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch, which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.

Pediatric Wrist.

Pediatric wrist injuries pose unique diagnostic challenges due to distinct bone characteristics in children and their diverse injury patterns. The dynamic development of the wrist, marked by changes in bone age and emerging ossification centers, is crucial to evaluate growth and identify potential pathologies. The skeletal composition, rich in cartilage, renders bones relatively weaker yet more elastic, impacting their susceptibility to fracture. Forearm fractures display diverse patterns influenced by torsional forces. Scaphoid fractures, less common in children, differ from those in adults. Conditions like Madelung's deformity and ulnar variance are more common wrist disorders in the pediatric population. In addition, the scarcity and nonspecificity of symptoms in those with tendon injuries and triangular fibrocartilage complex lesions can be diagnostically challenging. This article reviews pediatric wrist injuries, emphasizing ossification patterns, common fracture types, and developmental variants. Grasping these complexities in pediatric wrist development and associated pathologies is essential for precise diagnosis and treatment.

Needle Arthroscopy Versus Conventional Arthroscopy in the Evaluation of Carpal Pathology: A Comparative Study.

The needle scope is a less invasive intervention to evaluate carpal pathology. We hypothesize that there is no difference in the evaluation and diagnostic capability of the needle scope versus the conventional wrist arthroscope. Twenty patients indicated for wrist arthroscopy were prospectively enrolled. Prior to insertion of the 2.7-mm arthroscope, the needle scope evaluated for synovitis; cartilage damage (location and modified Outerbridge classification); integrity of the volar, scapholunate (SL), and lunotriquetral ligaments; and the triangular fibrocartilage complex (TFCC). Following needle scope evaluation, the surgeon completed a survey regarding the visualization and diagnosis. The 2.7-mm arthroscope was then inserted, and the surgeon completed the second portion of the survey. Statistical analysis was then completed to determine statistical significance. Twelve patients were female (60%), and the mean age was 39.8 years (±11.8 years). Eleven patients underwent arthroscopy for TFCC pathology, 4 patients for SL tearing, and 5 patients for extensive synovitis. There was no difference between the needle scope and wrist arthroscopy diagnosis. There was no difference between radiocarpal and midcarpal visualization. Surgeon-rated ease of use and diagnostic confidence were the same between two groups. The needle scope was better able to visualize the scapho-trapezium-trapezoid and carpometacarpal joints; however, the image was of marginally decreased quality. In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. II (prospective cohort study)-Diagnostic.

Effect of dorsal capsular imbrication on intraoperative DRUJ instability following arthroscopic TFCC repair surgery

BackgroundTo assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability.MethodsWe conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after “Cross-form TFCC repair” (CR) and Group 2 (90 cases) with a positive ballottement test after “Cross-form TFCC repair” and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively.ResultsBoth groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the “CR” and “CR + DCI” groups, respectively, with a significant difference. Despite the “CR + DCI” group initially exhibiting inferior ROM compared with the “CR” group, subsequently, no significant difference was noted between them.ConclusionsDorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.

Post-surgical Rehabilitation Guidelines for Triangular Fibrocartilage Complex Foveal Repair: A Survey of Australian Hand and Wrist Surgeons.

Background: To restore distal radioulnar joint stability following injury to the Triangular Fibrocartilage Complex (TFCC), foveal repair surgery may be necessary. Post-surgery rehabilitation is prescribed to restore wrist and hand function; however, no universally accepted or definitive rehabilitation protocol currently exists. The aim of this study was to survey hand and wrist surgeons regarding their recommended postoperative rehabilitation protocols following TFCC foveal repair surgery. Methods: Australian hand and wrist surgeons were invited to complete a descriptive survey containing 10 questions. Questions included clinical recommendations for wrist and forearm immobilisation, range of motion (ROM) exercise timeframes and surgeon experience of TFCC rupture. Descriptive statistics and between-group (TFCC rupture vs. no-rupture) comparisons (Pearson's Chi2) were calculated. Results: Thirty-one surgeons completed the survey. Recommendations for post-surgery immobilisation ranged from 'not required' to 8 weeks (mode 6 weeks). Wrist and forearm ROM commencement time ranged from 'immediately' to 'later than 8 weeks' (mode 6 weeks). The most recommended orthosis was a 'sugar-tong' (57%). Thirty-seven percent (37%) reported experience of post-surgery re-rupture. Conclusions: While surgeon recommendations varied, the majority recommended 4- to 6-week timeframe for immobilisation and ROM exercise commencement. Additional clinical research is recommended to evaluate whether postoperative rehabilitation decisions influence patient outcomes. Level of Evidence: Level V (Therapeutic).

Evaluation and Management of Triangular Fibrocartilage Complex (TFCC) Injuries in the Athlete

Evaluation and Management of Triangular Fibrocartilage Complex (TFCC) Injuries in the Athlete

Biomechanics of the Trampoline Test in the Intact, Sectioned, and Repaired TFCC

Abstract Background Multiple techniques have been developed to detect a triangular fibrocartilage complex (TFCC) foveal detachment. One commonly used technique to evaluate TFCC integrity, the trampoline test, has had variable reliability. Questions/Purposes The purpose of this biomechanical experiment was to evaluate the suitability of the trampoline test in detecting TFCC foveal detachments. Methods In each of 10 cadaver arms, TFCC displacement near the ulnar fovea was measured using a plunger with increasing incremental loads in the intact wrist, after ulnar sectioning of the TFCC, and following TFCC repair. Results After the application of the eight incremental small weights, there was no significant difference in the relative displacement of the plunger between the intact case, after detachment of the ulnar aspect of the TFCC disc, and after repair (0.6 mm intact, 0.7 mm detached, and 0.7 repair). However, there were significant differences in the absolute ending point displacement referenced to the starting intact position (0.6 mm intact, 1.3 mm detached, and −0.9 mm after repair). Conclusion/Clinical Relevance This study suggests that the trampoline test may not be adequate to quantify displacement (bouncing) of the TFCC disc after injury.