PDF herunterladen
J Wrist Surg 2019; 08(05): 403-407
DOI: 10.1055/s-0039-1688949
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair

Eric J. Sarkissian 
1   Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
,
Matthew B. Burn
1   Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
,
Jeffrey Yao
1   Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
› Institutsangaben
Weitere Informationen

Publikationsverlauf

21. Januar 2019

09. April 2019

Publikationsdatum:
27. Mai 2019 (online)

    Lizenzen und Reprints

Abstract

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results.

Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs.

Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient.

Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention.

Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears.

Level of Evidence This is a Level IV, therapeutic study.

Keywords

triangular fibrocartilage complex (TFCC) - pre-tied suture - all-arthroscopic repair

Ethical Review Committee Statement

IRB approved (Protocol 33895).


 

  • References

  • 1 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 (07) 1086-1106
    CrossrefPubMedGoogle Scholar
  • 2 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (05) 681-682
    CrossrefPubMedGoogle Scholar
  • 3 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
    CrossrefPubMedGoogle Scholar
  • 4 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
    PubMedGoogle Scholar
  • 5 Palmer AK, Werner FW, Glisson RR, Murphy DJ. Partial excision of the triangular fibrocartilage complex. J Hand Surg Am 1988; 13 (03) 391-394
    PubMedGoogle Scholar
  • 6 Palmer AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy 1990; 6 (02) 125-132
    CrossrefPubMedGoogle Scholar
  • 7 Haugstvedt J-R, Berger RA, Nakamura T, Neale P, Berglund L, An K-N. 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 (03) 445-451
    PubMedGoogle Scholar
  • 8 Bednar MS, Arnoczky SP, Weiland AJ. The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am 1991; 16 (06) 1101-1105
    CrossrefPubMedGoogle Scholar
  • 9 Park MJ, Jagadish A, Yao J. The rate of triangular fibrocartilage injuries requiring surgical intervention. Orthopedics 2010; 33 (11) 806
    PubMedGoogle Scholar
  • 10 Adams BD, Leversedge FJ. Distal Radioulnar Joint. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. , eds. Green's Operative Hand Surgery, 7th ed. Philadelphia, PA: Elsevier, Inc.; 2017: 479-515
    Google Scholar
  • 11 Wysocki RW, Richard MJ, Crowe MM, Leversedge FJ, Ruch DS. Arthroscopic treatment of peripheral triangular fibrocartilage complex tears with the deep fibers intact. J Hand Surg Am 2012; 37 (03) 509-516
    CrossrefPubMedGoogle Scholar
  • 12 Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018; 5 (01) 6
    CrossrefPubMedGoogle Scholar
  • 13 Whipple TL, Geissler WB. Arthroscopic management of wrist triangular fibrocartilage complex injuries in the athlete. Orthopedics 1993; 16 (09) 1061-1067
    PubMedGoogle Scholar
  • 14 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
    CrossrefPubMedGoogle Scholar
  • 15 Estrella EP, Hung L-K, Ho P-C, Tse WL. Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 2007; 23 (07) 729-737 , 737.e1
    CrossrefPubMedGoogle Scholar
  • 16 Pederzini LA, Tosi M, Prandini M, Botticella C. All-inside suture technique for Palmer class 1B triangular fibrocartilage repair. Arthroscopy 2007; 23 (10) 1130.e1-1130.e4
    PubMedGoogle Scholar
  • 17 Yao J. All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clin 2011; 27 (03) 237-242
    CrossrefPubMedGoogle Scholar
  • 18 Haugstvedt JR, Søreide E. Arthroscopic management of triangular fibrocartilage complex peripheral injury. Hand Clin 2017; 33 (04) 607-618
    CrossrefPubMedGoogle Scholar
  • 19 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
    CrossrefPubMedGoogle Scholar
  • 20 Yao J, Dantuluri P, Osterman AL. A novel technique of all-inside arthroscopic triangular fibrocartilage complex repair. Arthroscopy 2007; 23 (12) 1357.e1-1357.e4
    CrossrefPubMedGoogle Scholar
  • 21 Yao J. All-arthroscopic triangular fibrocartilage complex repair: safety and biomechanical comparison with a traditional outside-in technique in cadavers. J Hand Surg Am 2009; 34 (04) 671-676
    CrossrefPubMedGoogle Scholar
  • 22 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
    CrossrefPubMedGoogle Scholar
  • 23 Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011; 27 (03) 263-272
    CrossrefPubMedGoogle Scholar
  • 24 Nikiphorou E, Radner H, Chatzidionysiou K. , et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature. Arthritis Res Ther 2016; 18 (01) 251
    CrossrefPubMedGoogle Scholar
  • 25 Strauss NL, Goldfarb CA. Arthroscopic management of traumatic peripheral triangular fibrocartilage complex tears. J Hand Surg Am 2011; 36 (01) 136-138
    CrossrefPubMedGoogle Scholar
  • 26 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
    CrossrefPubMedGoogle Scholar
  • 27 Reiter A, Wolf MB, Schmid U. , et al. Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy 2008; 24 (11) 1244-1250
    CrossrefPubMedGoogle Scholar
  • 28 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
    CrossrefPubMedGoogle Scholar
  • 29 Trumble TE, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg Am 1997; 22 (01) 57-65
    PubMedGoogle Scholar
  • 30 Wolf MB, Haas A, Dragu A. , et al. Arthroscopic repair of ulnar-sided triangular fibrocartilage complex (Palmer Type 1B) tears: a comparison between short- and midterm results. J Hand Surg Am 2012; 37 (11) 2325-2330
    CrossrefPubMedGoogle Scholar
  • 31 Slutsky DJ. Outcomes assessment in wrist surgery. J Wrist Surg 2013; 2 (01) 1-4
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 32 Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84-A (02) 208-215
    PubMedGoogle Scholar
  • 33 Ruch DS, Papadonikolakis A. Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome. Arthroscopy 2005; 21 (09) 1126-1130
    CrossrefPubMedGoogle Scholar
  • 34 Badia A, Khanchandani P. Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears. Tech Hand Up Extrem Surg 2007; 11 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 35 Shih J-T, Lee H-M, Tan C-M. Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair. J Trauma 2002; 53 (05) 922-927
    CrossrefPubMedGoogle Scholar
  • 36 Haugstvedt JR, Husby T. Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (04) 439-447
    CrossrefPubMedGoogle Scholar
  • 37 Böhringer G, Schädel-Höpfner M, Petermann J, Gotzen L. A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy 2002; 18 (02) 211-213
    CrossrefPubMedGoogle Scholar
  • 38 Conca M, Conca R, Dalla Pria A. Preliminary experience of fully arthroscopic repair of triangular fibrocartilage complex lesions. Arthroscopy 2004; 20 (07) e79-e82
    CrossrefPubMedGoogle Scholar
  • 39 Lee CK, Cho HL, Jung KA, Jo JY, Ku JH. Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note. Knee Surg Sports Traumatol Arthrosc 2008; 16 (01) 94-97
    CrossrefPubMedGoogle Scholar
  • 40 del Piñal F, García-Bernal FJ, Cagigal L, Studer A, Regalado J, Thams C. A technique for arthroscopic all-inside suturing in the wrist. J Hand Surg Eur Vol 2010; 35 (06) 475-479
    CrossrefPubMedGoogle Scholar
  • 41 Millants P, De Smet L, Van Ransbeeck H. Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist. Chir Main 2002; 21 (05) 298-300
    CrossrefPubMedGoogle Scholar
  • 42 Waterman SM, Slade D, Masini BD, Owens BD. Safety analysis of all-inside arthroscopic repair of peripheral triangular fibrocartilage complex. Arthroscopy 2010; 26 (11) 1474-1477
    CrossrefPubMedGoogle Scholar
  • 43 Kuremsky MA, Habet N, Peindl RD, Gaston RG. Proximity of the triangular fibrocartilage complex to key surrounding structures and safety assessment of an arthroscopic repair technique: a cadaveric study. Arthroscopy 2016; 32 (12) 2490-2494
    CrossrefPubMedGoogle Scholar