Arthroskopische Refixation des TFCC bei ulnarer Ruptur

Zusammenfassung

Genaue anatomische und biomechanische Untersuchungen sowie klinische Erfahrungen haben in den letzten Jahren unsere Kenntnisse über die Funktion und Pathologie des distalen Radioulnargelenkes (DRUG) erweitert, sodass eine differenzierte Behandlung möglich ist. Bei Verletzungen reißt häufig der ulnare Teil des triangulären Faserkomplexes (TFCC). Die Entwicklung der verschiedenen arthroskopischen Techniken zur Rekonstruktion und der aktuelle Kenntnisstand werden im Folgenden dargestellt. Der ulnare Teil des TFCC ist in einen oberflächlichen, für die Stabilität weniger bedeutenden und einen wichtigeren, tiefen in der Fovea ansetzenden Teil zu unterscheiden. Beide Teile können zusammen oder jeweils einzeln abreißen. Schlüssel zur Diag­nose sind die klinische Untersuchung und die Arthroskopie. Bei der klinischen Untersuchung ist eine Instabilität im Seitenvergleich und soweit möglich das Ausmaß der Instabilität festzustellen und auf extraartikuläre Begleitverletzungen zu achten. Arthroskopisch wird der TFCC von radiokarpal und mehr und mehr auch vom DRUG her dargestellt und palpatorisch beurteilt. Im Falle einer Avulsion in der Tiefe ist eine anatomisch korrekte Refixation an den Knochen angezeigt und nach den vorliegenden Studien und eigenen Erfahrungen erfolgreich. Im Falle einer sehr ausgeprägten Instabilität ist anzunehmen, dass das Ausmaß der Verletzung über den isolierten Abriss in der Fovea hinausgeht und eine alleinige Reinsertion nicht in allen Fällen ausreichend ist.

Abstract

Accurately performed anatomic and biomechanical studies as well as clinical experience during the last years have widened our knowledge about function and pathology of the distal radioulnar joint (DRUJ) making a differentiated treatment possible. In cases of trauma a rupture of the ulnar part of the triangular fibrocartilaginous complex (TFCC) frequently occurs. An overview is given on the development of different arthroscopic techniques for repair and the state of the art is presented. The ulnar part of the TFCC is constituted of the superficial part which is less important for stability and the deep part which is anchored to the fovea of the ulnar head. This deep part is the most important stabiliser of the DRUJ. Each of these parts may rupture separately or both of them may rupture at the same time. Keystones for diagnosis are clinical examination and arthroscopy. On clinical examination instability of the DRUJ is to be evaluated by comparing it to the contralateral side. Furthermore, the degree of instability should be estimated. Extraarticular associated lesions must also be assessed clinically. On arthroscopy the TFCC may be evaluated from the radiocarpal joint as well as from its undersurface, from the DRUJ. In cases of avulsion from the fovea, an anatomic reconstruction with reinsertion of the deep part to the bone is indicated and may be performed successfully according to the published studies and our own experience. If a severe instability is found on clinical examination it is to be supposed that more stabilising structures – then only the radioulnar ligaments – are affected and reinsertion of the deep fibres to the fovea may not be sufficient.

Schlüsselwörter

Arthroskopie - TFCC Refixation - DRUG - Instabilität -

Key words

arthroscopy - TFCC repair - DRUJ - instability

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