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Arthroscopic-Assisted Outside-In Repair of Triangular Fibrocartilage Complex Tears.

ABSTRACT: With advances in surgical instrumentation and techniques, as well as expanding surgical indications, wrist arthroscopy is now being used to treat a variety of conditions previously managed only with open techniques. Triangular fibrocartilage complex (TFCC) injuries remain among the most common causes of ulnar-sided wrist pain and can result from both acute and chronic mechanisms of injury. The most common mechanism of acute injury to the TFCC is a fall onto an outstretched hand with the wrist in a supinated, extended position. In patients with unrelenting pain, swelling, or mechanical symptoms despite a concerted effort at nonoperative management, which often consists of bracing, therapy, or injections, surgical intervention is often indicated. Treatment historically consisted of open exploration and repair; however, recently, arthroscopic-assisted and all-arthroscopic techniques have been described. We describe a safe, reproducible, and reliable surgical technique for arthroscopic-assisted outside-in repair of peripheral TFCC tears. In addition, a specific focus on surgical anatomy, including pearls and pitfalls for protecting the dorsal sensory branch of the ulnar nerve, is presented.

SUBMITTER: Frank RM

PROVIDER: S-EPMC4722249 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Arthroscopic-Assisted Outside-In Repair of Triangular Fibrocartilage Complex Tears.

Frank Rachel M RM Slikker William W Al-Shihabi Laith L Wysocki Robert W RW

Arthroscopy techniques 20151021 5

With advances in surgical instrumentation and techniques, as well as expanding surgical indications, wrist arthroscopy is now being used to treat a variety of conditions previously managed only with open techniques. Triangular fibrocartilage complex (TFCC) injuries remain among the most common causes of ulnar-sided wrist pain and can result from both acute and chronic mechanisms of injury. The most common mechanism of acute injury to the TFCC is a fall onto an outstretched hand with the wrist in ...[more]

PMID: 26900557

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Project description:Injury to the triangular fibrocartilage complex (TFCC) may cause chronic wrist pain and instability if left untreated. The current literature of adult cases suggests that arthroscopic treatment offers favorable outcomes and is associated with a low complication rate. This systematic review evaluated the outcomes of arthroscopic TFCC surgery in adolescents. A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Clinical Answers was conducted in May 2020. All studies reporting on (1) arthroscopic TFCC repair or debridement in (2) patients under the age of 19 years with (3) a minimum case number of four patients were extracted by two independent observers. The level of evidence of each study was assessed according to the Oxford Centre for Evidence-Based Medicine, and study quality was graded according to the Modified Coleman Methodology Score and the MINORS criteria. Clinical outcome scores, functional parameters, and any complications were reviewed. The selected search terms initially resulted in a total of 986 possible articles. The authors eventually identified eight papers (all LoE IV) for inclusion in this systematic review. A total of 254 patients with verified TFCC tears and a mean age of 16 years (range, 7-19) received arthroscopic repair (162 patients, 67.1% of total) or debridement (77 patients, 29.7% of total). Arthroscopic treatment resulted in low pain levels, high patient satisfaction, and a fast return to sport. Complications overall were sparse and consisted mainly of persistent wrist pain (n = 31) and temporary paresthesia (n = 6) of the dorsal sensory branch of the ulnar nerve. Recurrent tears were sparse, with only four reported cases due to sports participation. Wrist arthroscopy is a reliable surgical option for treating TFCC tears in adolescents. The results obtained are comparable to those published in the literature. However, the variety of repair techniques and the low level of evidence across all included articles demand further prospective studies.

Project description: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.

Dataset Information

Arthroscopic-Assisted Outside-In Repair of Triangular Fibrocartilage Complex Tears.

Publications

Arthroscopic-Assisted Outside-In Repair of Triangular Fibrocartilage Complex Tears.

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