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J Wrist Surg 2015; 04(01): 022-030
DOI: 10.1055/s-0035-1544226
Special Focus Section: Foveal Tears of the TFCC
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

Andrea Atzei
1   Fenice Hand Surgery and Rehabilitation Team, Treviso, Pordenone, Italy
,
Riccardo Luchetti
2   Rimini Hand and Rehabilitation Center, Rimini, Italy
,
Federica Braidotti
1   Fenice Hand Surgery and Rehabilitation Team, Treviso, Pordenone, Italy
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Publikationsdatum:
13. Februar 2015 (online)

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Abstract

Background Foveal disruption of the triangular fibrocartilage complex (TFCC) is associated with distal radioulnar joint (DRUJ) instability. TFCC fixation onto the fovea is the suitable treatment, which is not achieved by conventional arthroscopic techniques. We describe an all-inside arthroscopic technique that uses a suture anchor through distal DRUJ arthroscopy for foveal repair of the TFCC.

Materials and Methods Forty-eight patients with TFCC foveal tear and DRUJ instability were selected according to the Atzei–European Wrist Arthroscopy Society (EWAS) algorithm of treatment. Retrospective evaluation included pain, DRUJ instability, range of motion (ROM), grip strength, Modified Mayo Wrist Score (MMWS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) Score.

Description of Technique DRUJ arthroscopy was performed to débride the TFCC and the foveal area. Under arthroscopic guidance, a suture anchor was inserted via the distal foveal portal to repair the TFCC onto the fovea. Sutures were tied on the radiocarpal surface of the TFCC. Postoperative immobilization of forearm rotation was maintained for 4 weeks. Heavy tasks were allowed after 3 months.

Results After a mean follow-up of 33 months, pain improved significantly but remained moderate in four patients, severe in one. DRUJ instability resolved in 44 patients. Wrist ROM increased. Grip strength, MMWS, and DASH score improved significantly. Excellent and good MMWS equaled 83.3%. Forty-one patients (85.5%) resumed previous work and sport activities. As a postoperative complication, five patients experienced neuroapraxia of the dorsal sensory branch of the ulnar nerve (DSBUN) with full spontaneous recovery.

Conclusions With appropriate indications and patient selection, arthroscopic foveal repair of the TFCC may restore DRUJ stability and provide satisfactory results without significant complications.

Keywords

triangular fibrocartilage complex - TFCC - foveal repair - arthroscopy - DRUJ instability

Note

Work was done at Fenice Hand Surgery and Rehabilitation Team, Treviso, Pordenone, Italy


 

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