Download PDF
J Wrist Surg 2018; 07(01): 043-050
DOI: 10.1055/s-0037-1604394
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents

Sebastian Farr
1   Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
,
Marion Schüller
2   Department of Physical Medicine and Rehabilitation, Orthopedic Hospital Speising, Vienna, Austria
,
Rudolf Ganger
1   Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
,
Werner Girsch
1   Department of Pediatric Orthopedics and Adult Foot and Ankle Surgery, Orthopedic Hospital Speising, Vienna, Austria
› Author Affiliations
Further Information

Publication History

09 February 2017

26 June 2017

Publication Date:
24 July 2017 (online)

    Permissions and Reprints

Abstract

Background To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients.

Purpose The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents.

Materials and Methods We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE).

Results Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome.

Conclusion Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings.

Level of Evidence Level IV, therapeutic case series.

Keywords

adolescents - children - debridement - triangular fibrocartilage complex - resection - DRUJ

Note

This work was performed at the Orthopedic Hospital Speising, Vienna, Austria.


 

  • References

  • 1 Jeffries AO, Craigen MA, Stanley JK. Wear patterns of the articular cartilage and triangular fibrocartilaginous complex of the wrist: a cadaveric study. J Hand Surg Br 1994; 19 (03) 306-309
    CrossrefPubMedGoogle Scholar
  • 2 Farr S, Grill F, Ganger R, Graf A, Girsch W. Pathomorphologic findings of wrist arthroscopy in children and adolescents with chronic wrist pain. Arthroscopy 2012; 28 (11) 1634-1643
    CrossrefPubMedGoogle Scholar
  • 3 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
  • 4 Andersson JK, Lindau T, Karlsson J, Fridén J. Distal radio-ulnar joint instability in children and adolescents after wrist trauma. J Hand Surg Eur Vol 2014; 39 (06) 653-661
    CrossrefPubMedGoogle Scholar
  • 5 Unglaub F, Kroeber MW, Thomas SB. , et al. Incidence and distribution of blood vessels in punch biopsies of Palmer 1A disc lesions in the wrist. Arch Orthop Trauma Surg 2009; 129 (05) 631-634
    CrossrefPubMedGoogle Scholar
  • 6 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
  • 7 Darlis NA, Weiser RW, Sotereanos DG. Arthroscopic triangular fibrocartilage complex debridement using radiofrequency probes. J Hand Surg Br 2005; 30 (06) 638-642
    CrossrefPubMedGoogle Scholar
  • 8 Tan SW, Ng SW, Tan SH, Teoh LC. Arthroscopic debridement of intercarpal ligament and triangular fibrocartilage complex tears. Singapore Med J 2012; 53 (03) 188-191
    PubMedGoogle Scholar
  • 9 Minami A, Ishikawa J, Suenaga N, Kasashima T. Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement. J Hand Surg Am 1996; 21 (03) 406-411
    CrossrefPubMedGoogle Scholar
  • 10 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
  • 11 Osterman AL. Arthroscopic debridement of triangular fibrocartilage complex tears. Arthroscopy 1990; 6 (02) 120-124
    CrossrefPubMedGoogle Scholar
  • 12 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
  • 13 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
  • 14 Möldner M, Unglaub F, Hahn P, Müller LP, Bruckner T, Spies CK. Functionality after arthroscopic debridement of central triangular fibrocartilage tears with central perforations. J Hand Surg Am 2015; 40 (02) 252-258.e2
    CrossrefPubMedGoogle Scholar
  • 15 De Smet L, De Ferm A, Steenwerckx A, Dauwe D, Zachee B, Fabry G. Arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist. Acta Orthop Belg 1996; 62 (01) 8-13
    PubMedGoogle Scholar
  • 16 Nishizuka T, Tatebe M, Hirata H, Shinohara T, Yamamoto M, Iwatsuki K. Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain. Bone Joint J 2013; 95-B (12) 1687-1696
    CrossrefPubMedGoogle Scholar
  • 17 Farr S, Grill F, Girsch W. Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases. Int Orthop 2012; 36 (06) 1215-1220
    CrossrefPubMedGoogle Scholar
  • 18 Farr S, Zechmann U, Ganger R, Girsch W. Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents–technique and results. Int Orthop 2015; 39 (08) 1571-1577
    CrossrefPubMedGoogle Scholar
  • 19 Terry CL, Waters PM. Triangular fibrocartilage injuries in pediatric and adolescent patients. J Hand Surg Am 1998; 23 (04) 626-634
    CrossrefPubMedGoogle Scholar
  • 20 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
    CrossrefPubMedGoogle Scholar
  • 21 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
    PubMedGoogle Scholar
  • 22 Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am 1994; 19 (01) 143-154
    CrossrefPubMedGoogle Scholar
  • 23 Germann G, Wind G, Harth A. The DASH(Disability of Arm-Shoulder-Hand) Questionnaire–a new instrument for evaluating upper extremity treatment outcome [Article in German]. Handchir Mikrochir Plast Chir 1999; 31 (03) 149-152
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 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
  • 25 John M, Angst F, Awiszus F, Pap G, Macdermid JC, Simmen BR. The patient-rated wrist evaluation (PRWE): cross-cultural adaptation into German and evaluation of its psychometric properties. Clin Exp Rheumatol 2008; 26 (06) 1047-1058
    PubMedGoogle Scholar
  • 26 Goslings JC, Gouma DJ. What is a surgical complication?. World J Surg 2008; 32 (06) 952
    CrossrefPubMedGoogle Scholar
  • 27 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
  • 28 Jang E, Danoff JR, Rajfer RA, Rosenwasser MP. Revision wrist arthroscopy after failed primary arthroscopic treatment. J Wrist Surg 2014; 3 (01) 30-36
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Farr S, Ganger R, Girsch W. A unique case of temporary epiphysiodesis in an adolescent patient with ulnocarpal impaction syndrome. J Hand Surg Eur Vol 2013; 38 (09) 1003-1004
    CrossrefPubMedGoogle Scholar
  • 30 De Smet L, Van Nuffel M, Koorneef P, Degreef I. Arthroscopic debridement with and without distal ulnar resection in the treatment of triangular fibrocartilage complex tears. Acta Orthop Belg 2014; 80 (01) 112-115
    PubMedGoogle Scholar
  • 31 Tomaino MM, Weiser RW. Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance. J Hand Surg Am 2001; 26 (06) 1047-1052
    CrossrefPubMedGoogle Scholar
  • 32 Van Sanden S, De Smet L. Ulnar shortening after failed arthroscopic treatment of triangular fibrocartilage complex tears. Chir Main 2001; 20 (05) 332-336
    CrossrefPubMedGoogle Scholar
  • 33 Hulsizer D, Weiss AP, Akelman E. Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex. J Hand Surg Am 1997; 22 (04) 694-698
    CrossrefPubMedGoogle Scholar
  • 34 Broccoli G, Vaske B, Müller L, Kahmann R, Isenberg J. Limits to arthroscopic treatment of degenerative triangular fibrocartilage complex lesions depending on the ulnar variance [in German]. Handchir Mikrochir Plast Chir 2014; 46 (03) 151-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 35 Adams BD. Partial excision of the triangular fibrocartilage complex articular disk: a biomechanical study. J Hand Surg Am 1993; 18 (02) 334-340
    CrossrefPubMedGoogle Scholar
  • 36 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