Patient-Reported Outcomes following Arthroscopic Triangular Fibrocartilage Complex Repair

Abstract

Background Triangular fibrocartilage complex (TFCC) injury is a common cause of ulnar-sided wrist pain, which may lead to serious physical impairments. Arthroscopic repair has benefits such as less soft tissue damage, greater surgical accuracy, and may lead to faster recovery than open repair.

Objective The purpose of this study was to determine the functional outcome of patients with symptomatic TFCC injuries treated with arthroscopic debridement or repair.

Patients and Methods A retrospective study of all consecutive patients with a TFCC injury treated arthroscopically was conducted. The primary outcome was the patient-rated wrist evaluation (PRWE) score. Secondary outcomes were, pain, operative findings, complications, and additional treatment.

Results A total of 51 patients with a median follow-up of 16.5 months (interquartile range [IQR]: 13–25) were included. Injuries were treated with TFCC debridement (n = 25), TFCC ligament to capsule suturing (n = 10), TFCC debridement and ligament to capsule suturing (n = 7), TFCC debridement and synovectomy (n = 5), and TFCC foveal reinsertion with a suture anchor (n = 4). The median PRWE was 19.5 (IQR: 6–49). Complications occurred in three patients and in nine patients additional surgery was performed.

Conclusion Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes.

Level of Evidence This is a Level IV study.

Keywords

TFCC - arthroscopy - repair - debridement - PRWE

Note

The work was performed in the Maasstad Hospital.

• References

• 1 Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 1991; 16 (02) 340-346
• 2 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist—anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
• 3 Mannil L, Martin W, Dahmen J. , et al. Arthroscopic treatment for ulnar-sided TFCC-tears. Eur J Trauma Emerg Surg 2016; 42 (01) 29-35
• 4 Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am 1994; 19 (01) 143-154
• 5 Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA. Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 2008; 33 (05) 675-682
• 6 Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008; 12 (04) 226-235
• 7 Kim B, Yoon HK, Nho JH. , et al. Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient. Arthroscopy 2013; 29 (11) 1762-1768
• 8 Farr S, Schüller M, Ganger R, Girsch W. Outcomes after arthroscopic debridement of the triangular fibrocartilage complex in adolescents. J Wrist Surg 2018; 7 (01) 43-50
• 9 Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins N. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy 1997; 13 (01) 78-84
• 10 Luchetti R, Atzei A. Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears. J Hand Surg Eur Vol 2017; 42 (04) 346-351
• 11 Bayoumy MA, Elkady HA, Said HG, El-Sayed A, Saleh WR. Short-term evaluation of arthroscopic outside-in repair of ulnar side TFCC tear with vertical mattress suture. J Orthop 2015; 13 (04) 455-460
• 12 Tang JB. Re: levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 2009; 34 (01) 137-138
• 13 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
• 14 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 15 Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011; 27 (03) 263-272
• 16 Estrella EP, Hung LK, Ho PC, Tse WL. Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 2007; 23 (07) 729-737 , 737.e1
• 17 Soreide E, Husby T, Haugstvedt JR. A long-term (20 years') follow-up after arthroscopically assisted repair of the TFCC. J Plast Surg Hand Surg 2017; 51 (05) 296-300
• 18 Ng AWH, Griffith JF, Fung CSY. , et al. MR imaging of the traumatic triangular fibrocartilaginous complex tear. Quant Imaging Med Surg 2017; 7 (04) 443-460
• 19 Bendre HH, Oflazoglu K, van Leeuwen WF, Rakhorst H, Ring D, Chen NC. The prevalence of triangular fibrocartilage complex signal abnormalities on magnetic resonance imaging relative to clinical suspicion of pathology. J Hand Surg Am 2018; 43 (09) 819-826.e1
• 20 Walenkamp MM, de Muinck Keizer RJ, Goslings JC, Vos LM, Rosenwasser MP, Schep NW. The minimum clinically important difference of the patient-rated wrist evaluation score for patients with distal radius fractures. Clin Orthop Relat Res 2015; 473 (10) 3235-3241
• 21 Yao J, Lee AT. All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. J Hand Surg Am 2011; 36 (05) 836-842