Article
Mid- and Longterm Results after Transosseous TFCC Refixation
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Published: | February 6, 2020 |
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Objectives/Interrogation: The Triangular Fibrocartilagious Complex (TFCC) is composed of the articular disc, the meniscus homologue, the ulnolunate and ulnotriquetral ligaments, the dorsal and palmar radioulnar ligaments (RUL) and the extensor carpi ulnaris (ECU) tendon sheat. The palmar and the dorsal ulnoradial ligament are considered the primary stabilizers of the distal radioulnar joint (DRUJ) during rotation. Lesions of the TFCC especially the ulnoradial ligaments may be the cause of ulnar sided wrist pain. Different surgical procedures addressing the instability problem with open, arthroscopic or arthroscopically assisted repair of the foveal attachment have been described. Short-term outcome reports of these methods indicate favorable results, but the long-term outcome remains to be reported. In the present study, we report the clinical mid- and long-term outcome of patients treated with arthroscopically-assisted transosseous reattachment of the deep TFCC insertion.
Methods: We included patients suffering from TFCC avulsions classified as Palmar type 1B with arthroscopically evaluated avulsion of the radio-ulnar ligaments who were treated with wrist arthroscopy and transosseous re-fixation of the TFCC between 2000 and 2009. Functional and clinical outcome of the patients were objectively measured with the Mayo Modified Wrist Score (MMWS), a Disabilities of the Arm, Shoulder and Hand (DASH) Score and a Patient Rated Wrist Examination (PRWE) score.
Results and Conclusions: We included 27 patients (18 female, 9 male) in this study. The first follow-up examination was at a mean of 25 months. All evaluated clinical measures significantly improved at first follow-up investigation compared to measures obtained preoperatively. At a mean of 84.5 months (range 32 - 128 months) the final follow-up examination was performed. Compared to preoperative measures, DASH score, mayo wrist score, and VAS remained significantly improved. Stability assessment showed a stable DRUJ in 17 patients (62.9%). In 9 patients (33.3%) moderate instability was assessed, while in 1 patient (3.7%) clear instability was observed. We did not observe differences in the MMWS and PRWE score between patients with stable, patients with moderate instability, and patients with unstable DRUJ.We found overall satisfying results at both evaluated time points with mainly excellent clinical outcome and high rates of patient satisfaction. Our results are comparable to short-term and mid-term outcome reported in literature.