Arthroscopic Foveal Repair with Suture Anchors for Traumatic Tears of the Triangular Fibrocartilage Complex

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2022 Jul 5

PMID 35788222

Authors

Kuang-Ting Yeh

Wen-Tien Wu

Jen-Hung Wang

Jui-Tien Shih

Affiliations

Soon will be listed here.

Abstract

Background: Foveal tears of the traumatic triangular fibrocartilage complex (TFCC) are the most commonly neglected high-energy injuries of the wrist joint, and the patients with such tears often experience unrecovered ulnar-sided wrist pain and poor wrist function. This study investigated the functional outcomes of patients who underwent arthroscopic repair of foveal TFCC tears with suture anchors and adjuvant platelet-rich plasma (PRP) injections after the surgery.

Methods: From September 2014 to August 2018, 156 men and 45 women with diagnoses of foveal TFCC tears without wrist fractures underwent arthroscopic repair by using the outside-in method with 1.3-mm suture anchors and subsequent PRP injection. After surgery, splinting was applied for 6 weeks, and the patients underwent rehabilitation, re-examination, and follow-up at our clinic. The patients' wrist functional scores and grip strength data were retrospectively collected.

Results: The mean follow-up period was 32.6 months, and the mean age was 26.7 years. The mean modified Mayo wrist score improved from 48.5 ± 2.6 to 82.4 ± 2.5, whereas the mean Disabilities of the Arm, Shoulder and Hand (DASH) score decreased from 39.2 ± 6.7 to 10.6 ± 7.5. Overall, the wrist functions of 186 (92.5%) of the patients were satisfactory according to their modified Mayo wrist scores, and the patients with satisfactory scores returned to sports or work activities. These patients retained normal ranges of motion, and their average grip strength in the affected hand was restored to at least 85% of that of the other hand.

Conclusions: According to the postoperative 25-36 months surgical results of our study, arthroscopic repair with adjuvant PRP injections is a satisfactory method of repairing early foveal tears of the TFCC and can enhance wrist function by relieving pain and increasing tolerance for work or sports.

Citing Articles

Effectiveness of Platelet-rich Plasma Injection as an Adjunct Treatment to Arthroscopy for TFCC Injury: A Retrospective Cohort Study.

Asiry A, Dabbagh A, Mortada H, Merlini L Plast Reconstr Surg Glob Open. 2024; 12(10):e6237.

PMID: 39391675 PMC: 11466133. DOI: 10.1097/GOX.0000000000006237.

Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review.

Ma H, Wang J, Yang C J Orthop Surg Res. 2024; 19(1):72.

PMID: 38229172 PMC: 10790567. DOI: 10.1186/s13018-024-04530-4.

References

Steiner M, Calandruccio J . Biologic Approaches to Problems of the Hand and Wrist. Orthop Clin North Am. 2017; 48(3):343-349. DOI: 10.1016/j.ocl.2017.03.010. View

Golimbu C, Firooznia H, Melone Jr C, Rafii M, WEINREB J, Leber C . Tears of the triangular fibrocartilage of the wrist: MR imaging. Radiology. 1989; 173(3):731-3. DOI: 10.1148/radiology.173.3.2813778. View

Hudak P, Amadio P, Bombardier C . Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996; 29(6):602-8. DOI: 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L. View

Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, Fuente M . Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res. 2005; 23(2):281-6. DOI: 10.1016/j.orthres.2004.08.015. View

Chidgey . The Distal Radioulnar Joint: Problems and Solutions. J Am Acad Orthop Surg. 1995; 3(2):95-109. DOI: 10.5435/00124635-199503000-00005. View

Munk P, Vellet A, Levin M, Steinbach L, Helms C . Current status of magnetic resonance imaging of the wrist. Can Assoc Radiol J. 1992; 43(1):8-18. View

Mishra A, Woodall Jr J, Vieira A . Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med. 2008; 28(1):113-25. DOI: 10.1016/j.csm.2008.08.007. View

Cooney W, Linscheid R, Dobyns J . Triangular fibrocartilage tears. J Hand Surg Am. 1994; 19(1):143-54. DOI: 10.1016/0363-5023(94)90238-0. View

Bednar J, Osterman A . The role of arthroscopy in the treatment of traumatic triangular fibrocartilage injuries. Hand Clin. 1994; 10(4):605-14. View

10.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

11.

Palmer A, Werner F . Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res. 1984; (187):26-35. View

12.

Pederzini L, Luchetti R, Soragni O, Alfarano M, Montagna G, Cerofolini E . Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy. 1992; 8(2):191-7. DOI: 10.1016/0749-8063(92)90036-b. View

13.

Palmer A, Werner F, Glisson R, Murphy D . Partial excision of the triangular fibrocartilage complex. J Hand Surg Am. 1988; 13(3):391-4. DOI: 10.1016/s0363-5023(88)80015-7. View

14.

Adams B, Holley K . Strains in the articular disk of the triangular fibrocartilage complex: a biomechanical study. J Hand Surg Am. 1993; 18(5):919-25. DOI: 10.1016/0363-5023(93)90066-C. View

15.

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):1371-8. DOI: 10.1016/j.arthro.2011.05.020. View

16.

Omarini L, Garcia J . [Magnetic resonance imaging of lesions of the triangular carpal ligament]. Schweiz Med Wochenschr. 1995; 125(17):854-9. View

17.

Kim B, Yoon H, Nho J, Park K, Park S, Yoon J . Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient. Arthroscopy. 2013; 29(11):1762-8. DOI: 10.1016/j.arthro.2013.08.022. View

18.

Trumble T, Gilbert M, Vedder N . Arthroscopic repair of the triangular fibrocartilage complex. Arthroscopy. 1996; 12(5):588-97. DOI: 10.1016/s0749-8063(96)90199-1. View

19.

Meaney Murray M, Rice K, Wright R, Spector M . The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three-dimensional collagen-GAG scaffold. J Orthop Res. 2003; 21(2):238-44. DOI: 10.1016/S0736-0266(02)00142-0. View

20.

Li Y, Li T, Li J, Tang X, Li R, Xiong Y . Platelet-Rich Plasma Has Better Results for Retear Rate, Pain, and Outcome Than Platelet-Rich Fibrin After Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2021; 38(2):539-550. DOI: 10.1016/j.arthro.2021.05.023. View