Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability

• Published in: Injury Vol. 44; no. 3; pp. 386 - 390
• Main Authors: Tse, Wing-Lim, Lau, Sun-Wing, Wong, Wing Yee, Cheng, Hi-Shan, Chow, Ching-Shan, Ho, Pak-Cheong, Hung, Leung-Kim
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2013
• Subjects: Arthroscopy; Distal radioulnar joint; DRUJ instability; Follow-Up Studies; Hand Strength; Humans; Joint Instability - prevention & control; Orthopedics; Pain, Postoperative; Quality of Life; Range of Motion, Articular; Reconstruction; Reconstructive Surgical Procedures - methods; Recovery of Function; Retrospective Studies; Tendons - surgery; TFCC; Treatment Outcome; Triangular Fibrocartilage - injuries; Triangular Fibrocartilage - physiopathology; Triangular Fibrocartilage - surgery; Triangular fibrocartilage complex; Wrist Injuries - physiopathology; Wrist Injuries - surgery; Reconstruction; Arthroscopy; Distal radioulnar joint; Triangular fibrocartilage complex; DRUJ instability; TFCC
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2013.01.009

Abstract Purpose To report the 10-years’ experience of a novel arthroscopic assisted anatomical TFCC reconstruction in treatment of chronic DRUJ instability resulting from irreparable TFCC injuries. Materials and methods 15 patients (7 males, 8 females) with mean age of 37 (17–49) suffering from irreparable TFCC injuries received arthroscopic assisted reconstruction using palmaris longus graft. Three skin incisions were made with creation of one radial and one ulna tunnel for passage of graft following the path of dorsal and palmar radio-ulnar ligaments under fluoroscopic and arthroscopic guidance. The joint capsule was kept intact. Early mid-range forearm rotation was started since 4th week postoperatively. Results The mean follow-up was 85.53 months (32–138). Mayo wrist score improved from 62.5 to 88( p < 0.05). Comparing contralateral side, total prono-supination range increased from 76.6% to 92.1% and grip strength increased from 56.1% to 76.9%. Twelve patients resumed previous jobs. No evidence of DRUJ arthritis was noticed. Complications included 2 late graft ruptures and one unexplained dystonia. Conclusions Our arthroscopic assisted approach on TFCC reconstruction is safe, produces comparable results as the standard technique and may achieve better range of motion with less soft tissue dissection and earlier mobilization.