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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Arthroscopic assisted tendon reconstruction for TFCC irreparable tears

Meeting Abstract

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  • presenting/speaker Riccardo Luchetti - Rimini Hand Centre, Rimini, Italy
  • Andrea Atzei - Fenice Hand Surgery & Rehabilitation Team, Treviso, Treviso, Italy
  • Roberto Cozzolino - Rimini Hand Centre, Rimini, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1737

doi: 10.3205/19ifssh0885, urn:nbn:de:0183-19ifssh08859

Published: February 6, 2020

© 2020 Luchetti et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: To report our 11-year experience performing arthroscopically assisted anatomical TFCC reconstruction in the treatment of chronic DRUJ instability resulting from irreparable TFCC injuries.

Methods: Eleven patients were submitted to reconstruction. Three skin incisions were made in order to create a radial and ulna tunnel for passage of the graft which is used to reconstruct the dorsal and palmar radio-ulnar ligament under fluoroscopic and arthroscopic guidance.

Results: Seven patients were affected by severe chronic DRUJ instability following distal radius fracture, 3 cases of DRUJ instability due to simple wrist sprain and one patient had instability due to TFCC wear following chronic calcium deposits. The ulnar styloid was un-united in two patients. All patients were classified arthroscopically as Palmer Type 1B, Atzei class 4; in two cases the avulsion was not reducible and in the other cases the patients had poor TFCC quality and poor healing potential. Two cases had instability recurrence after TFCC bone repair. One patient had associated luno-triquetral instability.

Pre-operative evaluation demonstrated that prono-supination ROM was almost complete in all patients but one (this patient had supination limited at 60°), all patients had evident and painful DRUJ instability, and grip strength was half of the contralateral side.

All patients (6 females and 5 male) with mean age 37 years, were evaluated at a mean follow-up of 68 months (range from 9 to 120 months).

At follow-up, DRUJ stability was restored in all but one patient, who was re-operated on using the Moritomo technique of open palmar tendon graft reconstruction. Pain decreased from 4 to 2 at rest and from 9 to 4 under stress according with the 0 to 10-points Visual Analogue Scale. Wrist ROM did not demonstrate significant modifications, but only a minimal decrease for pronation, flexion and extension. Grip strength increased from 54% to 96%. Modified Mayo Wrist Score was excellent in 4 patients and good in 5. Eight patients were satisfied with the results of the procedure: DASH and PRWHE scores improved (Table 2). Eight patients resumed previous manual activities (1 student), 3 patients changed work due to unrelated reasons.

Conclusions: Arthroscopic assisted approach for TFCC reconstruction is safe and produces comparable results as the standard technique.