gms | German Medical Science

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

TFCC Repair: Long-term follow-up after arthroscopic transosseous refixation

Meeting Abstract

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  • presenting/speaker Julian Dorn - Practice for Plastic- and Handsurgery, Dr. Baur & Dr. Fromberg, Murnau am Staffelsee, Germany
  • Robert Kemper - Practice for Plastic- and Handsurgery, Dr. Baur / Dr. Fromberg, Murnau am Staffelsee, Germany
  • Eva-Maria Baur - Practice for Plastic- and Handsurgery, Dr. Baur / Dr. Fromberg, Murnau am Staffelsee, Germany

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. DocIFSSH19-176

doi: 10.3205/19ifssh0887, urn:nbn:de:0183-19ifssh08875

Published: February 6, 2020

© 2020 Dorn 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

Text

Objectives/Interrogation: Since the introduction of arthroscopic refixation methods for ulnar avulsion lesions of the TFCC (Palmer IB) minimal invasive treatment has been continually gaining importance over the past two decades. A crucial progress was the anatomically correct transosseous reinsertion of the foveal attachment as described by Nakamura and others.

From 2007 to 2018 we treated close to 100 patients by a modification of Nakamura's technique, achieving promising results in short-term follow-up. Interestingly most of our patients are concerned "chronic lesions" with >6 month of symptoms.

There is still little data about long-term results of arthroscopic foveal refixation why we decided to clinically review an early sample of our collective.

Methods: Our operational technique is arthroscopically assisted transosseus refixation by opening the 6th extensor sheath, drill the holes on the floor of the sheath and tie the knot there. After refixation we gather the 6th extensor sheath, because especially in chronic cases it is commonly widened.

For this study we reexamined 10 patients with the longest follow-up times with modified Mayo-Wrist- and QuickDASH-score and clinically checked stability of the DRUJ. The average postoperative interval was 97 months (range 82-119 months). Average time since trauma / onset was 12 months (range 1-30 months, with 7 patients with >6 months of symptoms).

Results and Conclusions: Consistent with our former data every patient showed good stability of the DRUJ and satisfying to good pain relief. Pain at rest (or with load) was reduced from preoperative VAS 2,8 (6,5) to 0,5 (2,4). Average strength in pro-/supination and grip was equal in comparison to the contralateral side. Range of motion in pro-/supination was equal as well. Interestingly in an earlier follow-up (average 29 month after the operation) extension-flexion ROM was reduced (89%) but recovered in the long-term follow-up (97%).

An average modified Mayo-Wrist-score of 92 and a QuickDASH value of 14 points shows a good functional outcome.

Our data confirms the long-term efficacy of transosseous refixation of the TFCC on the floor of the 6th extensor sheath combined with a gathering of the sheath, even in patients with >6 months of symptoms.

By now it is well known, that refixation back to the bone is an important issue in the repair of foveal disruptions of the TFCC. Maybe the gathering of the 6th extensor sheath plays an additional important role for long-term stability, especially in the chronic cases.