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J Wrist Surg 2021; 10(02): 144-149
DOI: 10.1055/s-0040-1721410
Scientific Article

Delayed Presentation of Unstable Triangular Fibrocartilage Complex Tears Treated with Volar Foveal Ligament Repair

Joseph S. Geller
1   University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
,
David P. Taormina
1   University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
,
Janelle D. Greene
2   Yale University School of Medicine, Department of Orthopedic Surgery and Rehabilitation, New Haven, Connecticut
,
Seth D. Dodds 
1   University of Miami Miller School of Medicine, Department of Orthopedic Surgery and Rehabilitation, Bascom Palmer Institute, Department of Ortho, Miami, Florida
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Abstract

Hypothesis An open volar surgical approach with suture anchor repair of the foveal ligament and temporary pinning of the distal radioulnar joint (DRUJ) is an effective way to treat DRUJ instability associated with chronic foveal tears of the triangular fibrocartilage complex (TFCC).

Methods We retrospectively reviewed nine patients with foveal ligament tears of the TFCC and DRUJ instability who underwent open repair of the TFCC using a volar surgical approach, combined with temporary pinning of the DRUJ for 8 weeks. Pain, instability, arc of motion, and functional outcomes scores were evaluated.

Results Mean patient age was 40.5 years (range 16.3–56.2). Average time from injury to surgery was 8.4 months (range 2.9–23.3 months). Average final follow-up was 18.9 months from injury (range 12.0–29.3 months), 10.5 months from surgery (range 3.9–18.6 months), and 8.7 months from pin removal (range 1.7–17.2 months). At final follow-up, all patients demonstrated clinically stable DRUJ. Pain scores diminished significantly from pre to final postoperative visits, with averages of 6.8 (range 4.0–9.0) improving to a mean of 0.70 (range 0.0–2.0), respectively. Average postoperative forearm rotation was 71.1 degrees in supination and 76.1 degrees in pronation (average total arc of motion 147.2 degrees, range 90–160 degrees). Average postoperative wrist motion was 68.8 degrees in flexion and 70.6 degrees in extension (average total arc of motion 139.4 degrees, range 110–160 degrees). No patients developed crepitus, recurrent DRUJ instability, or required revision surgery (subsequent to pin removal).

Conclusion Volar suture anchor repair of the foveal ligament of the TFCC with DRUJ pinning led to reliable outcomes within this patient group including a stable DRUJ with improved functional outcomes regarding pain, stability, and range of motion in patients with foveal TFCC tears and associated DRUJ instability. These results compare favorably with dorsal repair of the foveal ligament.

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

Keywords

foveal ligament - TFCC - volar approach - DRUJ instability


Publication History

Received: 31 August 2020

Accepted: 19 October 2020

Article published online:
03 January 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (N Y) 2007; 2 (03) 123-126
    CrossrefPubMedGoogle Scholar
  • 2 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
  • 3 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
    CrossrefPubMedGoogle Scholar
  • 4 Ward LD, Ambrose CG, Masson MV, Levaro F. The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability. J Hand Surg Am 2000; 25 (02) 341-351
    CrossrefPubMedGoogle Scholar
  • 5 Eltorai AEM, Akelman E. Orthopaedic Hand Trauma. Wolters Kluwer; 2020
    Google Scholar
  • 6 John T, Dodds SD. Acute triangular fibrocartilage tears. In Eltorai and Akelman, ed. Orthopaedic Hand Trauma. Philadelphia: Wolters Kluwer; 2019: 227-241
    Google Scholar
  • 7 Adams BD. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg 2000; 4 (03) 154-160
    CrossrefPubMedGoogle Scholar
  • 8 Meyer D, Schweizer A, Nagy L. Anatomic reconstruction of distal radioulnar ligaments with tendon graft for treating distal radioulnar joint instability: surgical technique and outcome. Tech Hand Up Extrem Surg 2017; 21 (03) 107-113
    CrossrefPubMedGoogle Scholar
  • 9 Teoh LC, Yam AK. Anatomic reconstruction of the distal radioulnar ligaments: long-term results. J Hand Surg [Br] 2005; 30 (02) 185-193
    CrossrefPubMedGoogle Scholar
  • 10 Tünnerhoff HG, Langer M. Arthroscopic repair for ulnar-sided tears of the TFCC. Handchir Mikrochir Plast Chir 2014; 46 (05) 286-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 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
  • 12 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 (04) 176-181
    CrossrefPubMedGoogle Scholar
  • 13 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
  • 14 Selles CA, d'Ailly PN, Schep NWL. Patient-reported outcomes following arthroscopic triangular fibrocartilage complex repair. J Wrist Surg 2020; 9 (01) 58-62
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Auzias P, Camus EJ, Moungondo F, Van Overstraeten L. Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: clinical and radiographic outcomes at 4 years' mean follow-up. Hand Surg Rehabil 2020; 39 (03) 193-200
    CrossrefPubMedGoogle Scholar
  • 16 Gillis JA, Soreide E, Khouri JS, Kadar A, Berger RA, Moran SL. Outcomes of the Adams-Berger ligament reconstruction for the distal radioulnar joint instability in 95 consecutive cases. J Wrist Surg 2019; 8 (04) 268-275
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Kootstra TJM, van Doesburg MH, Schuurman AH. Functional effects of the Adams procedure: a retrospective intervention study. J Wrist Surg 2018; 7 (04) 331-335
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Seo KN, Park MJ, Kang HJ. Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability. Clin Orthop Surg 2009; 1 (03) 138-145
    CrossrefPubMedGoogle Scholar
  • 19 Moritomo H. Open repair of the triangular fibrocartilage complex from palmar aspect. J Wrist Surg 2015; 4 (01) 2-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Garcia-Elias M, Hagert E. Surgical approaches to the distal radioulnar joint. Hand Clin 2010; 26 (04) 477-483
    CrossrefPubMedGoogle Scholar
  • 21 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
    CrossrefPubMedGoogle Scholar
  • 22 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
    CrossrefPubMedGoogle Scholar
  • 23 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
  • 24 Adams BD, Lawler E. Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 2007; 15 (09) 571-575
    CrossrefPubMedGoogle Scholar