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J Hand Microsurg 2020; 12(02): 116-122
DOI: 10.1055/s-0040-1713580
Original Article

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

Colin T. McNamara
1   Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
,
Salih Colakoglu
1   Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
,
Matthew L. Iorio 
1   Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
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Abstract

Triangular fibrocartilage complex (TFCC) injuries can present incidentally as an asymptomatic lesion or can cause acute and chronic pain. This study compared different treatment approaches for symptomatic Palmer Type 1 TFCC injuries and rates of improvement using a systematic review of the literature. Two hundred thirty-one articles were identified, 43 met criteria and were included. Two of these articles indicated conservative therapy may be adequate. Patients who underwent debridement for any Type 1 Palmer class returned to work at a rate of 92% (n = 182), but only 44% (n = 38) were free of pain. For 1B lesions that underwent repair, 68.3% (n = 226) were able to return to work and 41% (n = 52) had persistent pain. 1D lesions were treated with both repair and debridement with similar results. Data for Types 1A and 1C were limited as no authors solely addressed these lesions. For 1A lesions, those treated with traditional treatment of debridement still had high rates of being unable to return to work. The literature remains insufficient, making comparison between studies and techniques difficult. For asymptomatic injuries, there is no need for treatment. For patients with recalcitrant symptoms, surgery improves pain, grip strength, and increases return to work and activity. The level of evidence is IV.

Keywords

TFCC - open repair - arthroscopic repair - conservative management - wrist pain

Supplementary Appendix



Publication History

Article published online:
30 June 2020

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Thieme Medical and Scientific Publishers Private Ltd.
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  • References

  • 1 Kihara H, Short WH, Werner FW, Fortino MD, Palmer AK. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg Am 1995; 20 (06) 930-936
    CrossrefPubMedGoogle Scholar
  • 2 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
    PubMedGoogle Scholar
  • 3 Trumble TE, Gilbert M, Vedder N. Arthroscopic repair of the triangular fibrocartilage complex. Arthroscopy 1996; 12 (05) 588-597
    CrossrefPubMedGoogle Scholar
  • 4 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 5 Kirschenbaum D, Sieler S, Solonick D, Loeb DM, Cody RP. Arthrography of the wrist. Assessment of the integrity of the ligaments in young asymptomatic adults. J Bone Joint Surg Am 1995; 77 (08) 1207-1209
    CrossrefPubMedGoogle Scholar
  • 6 Iordache SD, Rowan R, Garvin GJ, Osman S, Grewal R, Faber KJ. Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. J Hand Surg Am 2012; 37 (01) 98-103
    CrossrefPubMedGoogle Scholar
  • 7 Brown JA, Janzen DL, Adler BD. et al Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain. Can Assoc Radiol J 1994; 45 (04) 292-296
    PubMedGoogle Scholar
  • 8 Löw S, Erne H, Pillukat T, Mühldorfer-Fodor M, Unglaub F, Spies CK. Diagnosing central lesions of the triangular fibrocartilage as traumatic or degenerative: a review of clinical accuracy. J Hand Surg Eur Vol 2017; 42 (04) 357-362
    CrossrefPubMedGoogle Scholar
  • 9 Miwa H, Hashizume H, Fujiwara K, Nishida K, Inoue H. Arthroscopic surgery for traumatic triangular fibrocartilage complex injury. J Orthop Sci 2004; 9 (04) 354-359
    CrossrefPubMedGoogle Scholar
  • 10 Tang C, Fung B, Chan R, Fok M. The beauty of stability: distal radioulnar joint stability in arthroscopic triangular fibrocartilage complex repair. Hand Surg 2013; 18 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Sarkissian EJ, Burn MB, Yao J. Long-term outcomes of all-arthroscopic pre-tied suture device triangular fibrocartilage complex repair. J Wrist Surg 2019; 8 (05) 403-407
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Ruch DS, Papadonikolakis A. Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome. Arthroscopy 2005; 21 (09) 1126-1130
    CrossrefPubMedGoogle Scholar
  • 15 Infanger M, Grimm D. Meniscus and discus lesions of triangular fibrocartilage complex (TFCC): treatment by laser-assisted wrist arthroscopy. J Plast Reconstr Aesthet Surg 2009; 62 (04) 466-471
    CrossrefPubMedGoogle Scholar
  • 16 Papapetropoulos PA, Wartinbee DA, Richard MJ, Leversedge FJ, Ruch DS. Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy. J Hand Surg Am 2010; 35 (10) 1607-1613
    CrossrefPubMedGoogle Scholar
  • 17 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
  • 18 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
  • 19 Deniz G, Kose O, Yanik S, Colakoglu T, Tugay A. Effect of untreated triangular fibrocartilage complex (TFCC) tears on the clinical outcome of conservatively treated distal radius fractures. Eur J Orthop Surg Traumatol 2014; 24 (07) 1155-1159
    CrossrefPubMedGoogle Scholar
  • 20 Mrkonjic A, Geijer M, Lindau T, Tägil M. The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: a 13-15 year follow-up of arthroscopically diagnosed but untreated injuries. J Hand Surg Am 2012; 37 (08) 1555-1560
    CrossrefPubMedGoogle Scholar
  • 21 Fujitani R, Omokawa S, Akahane M, Iida A, Ono H, Tanaka Y. Predictors of distal radioulnar joint instability in distal radius fractures. J Hand Surg Am 2011; 36 (12) 1919-1925
    CrossrefPubMedGoogle Scholar
  • 22 Bombaci H, Polat A, Deniz G, Akinci O. The value of plain X-rays in predicting TFCC injury after distal radial fractures. J Hand Surg Eur Vol 2008; 33 (03) 322-326
    CrossrefPubMedGoogle Scholar
  • 23 Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 1997; 22 (05) 638-643
    CrossrefPubMedGoogle Scholar
  • 24 Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res 2000; 376 (376) 229-235
    CrossrefPubMedGoogle Scholar
  • 25 Barlow SJ. A non-surgical intervention for triangular fibrocartilage complex tears. Physiother Res Int 2016; 21 (04) 271-276
    CrossrefPubMedGoogle Scholar
  • 26 Park MJ, Jagadish A, Yao J. The rate of triangular fibrocartilage injuries requiring surgical intervention. Orthopedics 2010; 33 (11) 806
    PubMedGoogle Scholar
  • 27 Palmer AK, Werner FW, Glisson RR, Murphy DJ. Partial excision of the triangular fibrocartilage complex. J Hand Surg Am 1988; 13 (03) 391-394
    CrossrefPubMedGoogle Scholar
  • 28 Adams BD, Holley KA. Strains in the articular disk of the triangular fibrocartilage complex: a biomechanical study. J Hand Surg Am 1993; 18 (05) 919-925
    CrossrefPubMedGoogle Scholar
  • 29 Soreide E, Haugstvedt JR, Husby T. Arthroscopic assisted resection of triangular fibrocartilage complex lesions: a 19-year follow-up. Hand (N Y) 2018; 13 (03) 325-330
    CrossrefPubMedGoogle Scholar
  • 30 Abe Y, Tominaga Y. Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports. Hand Surg 2011; 16 (02) 177-180
    CrossrefPubMedGoogle Scholar
  • 31 Husby T, Haugstvedt JR. Long-term results after arthroscopic resection of lesions of the triangular fibrocartilage complex. Scand J Plast Reconstr Surg Hand Surg 2001; 35 (01) 79-83
    CrossrefPubMedGoogle Scholar
  • 32 Westkaemper JG, Mitsionis G, Giannakopoulos PN, Sotereanos DG. Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries. Arthroscopy 1998; 14 (05) 479-483
    CrossrefPubMedGoogle Scholar
  • 33 Blackwell RE, Jemison DM, Foy BD. The holmium:yttrium-aluminum-garnet laser in wrist arthroscopy: a five-year experience in the treatment of central triangular fibrocartilage complex tears by partial excision. J Hand Surg Am 2001; 26 (01) 77-84
    CrossrefPubMedGoogle Scholar
  • 34 Arsalan-Werner A, Grüter L, Mehling IM, Moll W, Wölfle O, Sauerbier M. Results after arthroscopic treatment of central traumatic lesions of the triangular fibrocartilage complex. Arch Orthop Trauma Surg 2018; 138 (05) 731-737
    CrossrefPubMedGoogle Scholar
  • 35 McAdams TR, Swan J, Yao J. Arthroscopic treatment of triangular fibrocartilage wrist injuries in the athlete. Am J Sports Med 2009; 37 (02) 291-297
    CrossrefPubMedGoogle Scholar
  • 36 Cardenas-Montemayor E, Hartl JF, Wolf MB. et al Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint. Arch Orthop Trauma Surg 2013; 133 (02) 287-293
    CrossrefPubMedGoogle Scholar
  • 37 Thiru RG, Ferlic DC, Clayton ML, McClure DC. Arterial anatomy of the triangular fibrocartilage of the wrist and its surgical significance. J Hand Surg Am 1986; 11 (02) 258-263
    CrossrefPubMedGoogle Scholar
  • 38 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 (02) 271-277
    CrossrefPubMedGoogle Scholar
  • 39 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
  • 40 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
  • 41 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
  • 42 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
  • 43 de Araujo W, Poehling GG, Kuzma GR. New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies. Arthroscopy 1996; 12 (06) 699-703
    CrossrefPubMedGoogle Scholar
  • 44 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
  • 45 Woo SJ, Jegal M, Park MJ. Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury. Indian J Orthop 2016; 50 (03) 263-268
    CrossrefPubMedGoogle Scholar
  • 46 Park JH, Kim D, Park JW. Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear. Arch Orthop Trauma Surg 2018; 138 (01) 131-138
    CrossrefPubMedGoogle Scholar
  • 47 Roh YH, Hong SW, Gong HS, Baek GH. Prognostic factors of arthroscopic debridement for central triangular fibrocartilage complex tears in adults younger than 45 years: a retrospective case series analysis. Arthroscopy 2018; 34 (11) 2994-2998
    CrossrefPubMedGoogle Scholar
  • 48 Tang CY, Fung B, Rebecca C, Lung CP. Another light in the dark: review of a new method for the arthroscopic repair of triangular fibrocartilage complex. J Hand Surg Am 2012; 37 (06) 1263-1268
    CrossrefPubMedGoogle Scholar
  • 49 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
  • 50 Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 1991; 16 (02) 340-346
    CrossrefPubMedGoogle Scholar
  • 51 Chan JJ, Teunis T, Ring D. Prevalence of triangular fibrocartilage complex abnormalities regardless of symptoms rise with age: systematic review and pooled analysis. Clin Orthop Relat Res 2014; 472 (12) 3987-3994
    CrossrefPubMedGoogle Scholar
  • 52 Gupta R, Nelson SD, Baker J, Jones NF, Meals RA. The innervation of the triangular fibrocartilage complex: nitric acid maceration rediscovered. Plast Reconstr Surg 2001; 107 (01) 135-139
    CrossrefPubMedGoogle Scholar
  • 53 Unglaub F, Wolf MB, Dragu A, Schwarz S, Kroeber MW, Horch RE. Nerve fiber staining investigations in traumatic and degenerative disc lesions of the wrist. J Hand Surg Am 2011; 36 (05) 843-846
    CrossrefPubMedGoogle Scholar
  • 54 Saito T, Malay S, Chung KC. A systematic review of outcomes after arthroscopic débridement for triangular fibrocartilage complex tear. Plast Reconstr Surg 2017; 140 (05) 697e-708e
    CrossrefPubMedGoogle Scholar
  • 55 Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open versus arthroscopic repair of 1B ulnar-sided triangular fibrocartilage complex tears: a systematic review. Hand (N Y) 2020; 15 (04) 456-464
    CrossrefPubMedGoogle Scholar
  • 56 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
  • 57 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 (08) 845-855
    CrossrefPubMedGoogle Scholar