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J Wrist Surg 2015; 04(01): 002-008
DOI: 10.1055/s-0034-1398474
Special Focus Section: Foveal Tears of the TFCC
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Open Repair of the Triangular Fibrocartilage Complex from Palmar Aspect

Hisao Moritomo
1   Yukioka Hospital Hand Center, Osaka Yukioka College of Health Science, Osaka, Japan
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Publication History

Publication Date:
13 February 2015 (online)

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Abstract

Background Although foveal tears of the triangular fibrocartilage complex (TFCC) can be surgically reattached to the fovea via a dorsal approach, the foveal lesion is difficult to visualize from the dorsal side because the extensor carpi ulnaris (ECU) sheath floor and the superficial dorsal limb of the radioulnar ligament hinders the view of the fovea.

Materials and Methods Twenty-one patients with foveal tears were treated by an open repair method from the palmar aspect. Pain, instability, motion, and grip strength were evaluated after a mean follow-up period of 26 months, and each patient was rated according to the Mayo Modified Wrist Score (MMWS).

Description of Technique A 4-cm skin incision is made on the palmar aspect of the ulnar fovea. The ulnar fovea is exposed through a transverse capsulotomy of the distal radioulnar joint. The distal aspect of the TFCC is also exposed between the ECU tendon sheath and the ulnotriquetral ligament. After curettage of the scar tissue in the fovea, the deep palmar and dorsal limbs of the TFCC are sutured back to the fovea using a suture anchor technique.

Results Foveal TFCC tears could be repaired via a palmar surgical approach without violating the floor of the ECU tendon sheath and the superficial dorsal limb. Excellent results were achieved in 18 patients, and a good result was achieved in three.

Conclusions Our result compared favorably with those reported for dorsal approach. The palmar surgical approach facilitates the inspection and repair of the TFCC foveal tears.

Level of Evidence IV

Keywords

DRUJ instability - TFCC foveal tear - open repair - CT arthrography - surgical approach
 

  • References

  • 1 Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 1991; 16 (2) 340-346
    CrossrefPubMedSearch in Google Scholar
  • 2 Chou KH, Sarris IK, Sotereanos DG. Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears. J Hand Surg [Br] 2003; 28 (6) 546-550
    CrossrefPubMedSearch in Google Scholar
  • 3 Moritomo H, Masatomi T, Murase T, Miyake J, Okada K, Yoshikawa H. Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism. J Hand Surg Am 2010; 35 (12) 1955-1963
    CrossrefPubMedSearch in Google Scholar
  • 4 Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 2011; 27 (3) 281-290
    CrossrefPubMedSearch in Google Scholar
  • 5 Luchetti R, Atzei A, Cozzolino R, Fairplay T, Badur N. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability. J Hand Surg Eur Vol 2014; 39 (8) 845-855
    CrossrefPubMedSearch in Google Scholar
  • 6 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 (5) 836-842
    CrossrefPubMedSearch in Google Scholar
  • 7 Geissler WB. Arthroscopic knotless peripheral ulnar-sided TFCC repair. Hand Clin 2011; 27 (3) 273-279
    CrossrefPubMedSearch in Google Scholar
  • 8 Iwasaki N, Nishida K, Motomiya M, Funakoshi T, Minami A. Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study. Arthroscopy 2011; 27 (10) 1371-1378
    CrossrefPubMedSearch in Google Scholar
  • 9 Shinohara T, Tatebe M, Okui N, Yamamoto M, Kurimoto S, Hirata H. Arthroscopically assisted repair of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2013; 38 (2) 271-277
    CrossrefPubMedSearch in Google Scholar
  • 10 Garcia-Elias M, Hagert E. Surgical approaches to the distal radioulnar joint. Hand Clin 2010; 26 (4) 477-483
    CrossrefPubMedSearch in Google Scholar
  • 11 Garcia-Elias M, Smith DE, Llusá M. Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 2003; 7 (4) 134-140
    CrossrefPubMedSearch in Google Scholar
  • 12 Nakamura T, Nakao Y, Ikegami H, Sato K, Takayama S. Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg 2004; 8 (2) 116-123
    CrossrefPubMedSearch in Google Scholar
  • 13 Kleinman WB, Graham TJ. The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation. J Hand Surg Am 1998; 23 (4) 588-599
    CrossrefPubMedSearch in Google Scholar
  • 14 Moritomo H. Advantages of open repair of a foveal tear of the triangular fibrocartilage complex via a palmar surgical approach. Tech Hand Up Extrem Surg 2009; 13 (4) 176-181
    CrossrefPubMedSearch in Google Scholar
  • 15 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (1) 63-82
    PubMedSearch in Google Scholar
  • 16 Ishii S, Palmer AK, Werner FW, Short WH, Fortino MD. An anatomic study of the ligamentous structure of the triangular fibrocartilage complex. J Hand Surg Am 1998; 23 (6) 977-985
    CrossrefPubMedSearch in Google Scholar
  • 17 Garcia-Elias M. Soft-tissue anatomy and relationships about the distal ulna. Hand Clin 1998; 14 (2) 165-176
    PubMedSearch in Google Scholar
  • 18 Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 2006; 31 (3) 445-451
    CrossrefPubMedSearch in Google Scholar
  • 19 Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (7) 1086-1106
    CrossrefPubMedSearch in Google Scholar
  • 20 Moritomo H, Kataoka T. Palmar reconstruction of the triangular fibrocartilage complex for static instability of the distal radioulnar joint. Tech Hand Up Extrem Surg 2014; 18 (3) 110-115
    CrossrefPubMedSearch in Google Scholar
  • 21 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (4) 689-699
    CrossrefPubMedSearch in Google Scholar
  • 22 Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 2007; 32 (4) 438-444
    CrossrefPubMedSearch in Google Scholar
  • 23 Moritomo H. Differential diagnosis of ulnar wrist pain. Orthopaedics 2014; 27: 1-7 (Japanese)
    PubMedSearch in Google Scholar
  • 24 Moritomo H. Anatomy and clinical relevance of the ulnocarpal ligament. J Wrist Surg 2013; 2 (2) 186-189
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am 1994; 19 (1) 143-154
    CrossrefPubMedSearch in Google Scholar
  • 26 Hagert CG. Distal radius fracture and the distal radioulnar joint—anatomical considerations. Handchir Mikrochir Plast Chir 1994; 26 (1) 22-26
    PubMedSearch in Google Scholar
  • 27 Xu J, Tang JB. In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint. J Hand Surg Am 2009; 34 (1) 40-45
    PubMedSearch in Google Scholar
  • 28 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (2) 243-251
    CrossrefPubMedSearch in Google Scholar
  • 29 Scheker LR, Ozer K. Ligamentous stabilization of the distal radioulnar joint. Tech Hand Up Extrem Surg 2004; 8 (4) 239-246
    CrossrefPubMedSearch in Google Scholar
  • 30 Teoh LC, Yam AK. Anatomic reconstruction of the distal radioulnar ligaments: long-term results. J Hand Surg [Br] 2005; 30 (2) 185-193
    CrossrefPubMedSearch in Google Scholar