Arthroscopically Assisted Repair of Triangular Fibrocartilage Complex Foveal Tears

• Published in: The Journal of hand surgery (American ed.) Vol. 38; no. 2; pp. 271 - 277
• Main Authors: Shinohara, Takaaki, MD, PhD, Tatebe, Masahiro, MD, PhD, Okui, Nobuyuki, MD, PhD, Yamamoto, Michiro, MD, PhD, Kurimoto, Shigeru, MD, Hirata, Hitoshi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2013
• Subjects: Adolescent; Adult; Arthroscopic repair; Arthroscopy - methods; Disability Evaluation; distal radioulnar joint; Female; Follow-Up Studies; foveal tear; Hand Strength - physiology; Humans; instability; Joint Instability - diagnosis; Joint Instability - physiopathology; Male; Orthopedics; Pain, Postoperative - diagnosis; Pain, Postoperative - physiopathology; Triangular Fibrocartilage - injuries; Triangular Fibrocartilage - physiopathology; Triangular Fibrocartilage - surgery; triangular fibrocartilage complex; Wrist Injuries - physiopathology; Wrist Injuries - surgery; triangular fibrocartilage complex; foveal tear; distal radioulnar joint; Arthroscopic repair; instability
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2012.11.008

Purpose To give a detailed clinical outcome analysis of a consecutive series of patients treated arthroscopically for traumatic triangular fibrocartilage complex (TFCC) foveal tears. Methods This study was a consecutive case series of 11 patients who underwent arthroscopically assisted repair for traumatic TFCC foveal lesions. The mean age at the time of surgery was 27 years. The mean follow-up was 30 months (range, 20–51 mo). All patients underwent arthroscopy-assisted foveal reattachment of the TFCC by means of a transosseous outside-in technique. The primary outcome measure was a self-administered upper limb disability questionnaire (Hand20 questionnaire) at the final follow-up. The Hand20 scores range from 0 to 100, with high scores indicating severe disability. Secondary outcome measures included pain, grip strength, range of motion, distal radioulnar joint (DRUJ) instability, and the Mayo Modified Wrist Score. We assessed postoperative complications for all patients. Results The mean preoperative Hand20 score was 29; it decreased significantly to 6 at final follow-up. Pain completely resolved in 7 patients, whereas mild pain during activity persisted in 4 patients. Grip strength improved significantly after surgery, from 84% to 98% of the unaffected side. Nine patients had no DRUJ instability and 2 had mild DRUJ instability at final follow-up. The Mayo Modified Wrist Score at final follow-up was 94 points; results were excellent in 7 patients, good in 3, and fair in 1. Skin irritation at the ulnar neck caused by the suture thread was recognized as a postoperative complication in 3 patients. Conclusions Transosseous arthroscopic repair for traumatic TFCC foveal tear can restore stability to the DRUJ and provide satisfactory subjective and objective results without serious complications after more than 20 months' follow-up. Type of study/level of evidence Therapeutic IV.