Advertisement

Arthroscopic-Assisted Foveal Reattachment of Triangular Fibrocartilage Complex Tears With Distal Radioulnar Joint Instability: A Comparison of Suture Anchors and Transosseous Sutures

Published:March 24, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.01.021

      Purpose

      To compare the clinical outcomes of arthroscopically-assisted suture anchor repair and transosseous sutures for repair of foveal triangular fibrocartilage complex tears in patients with distal radioulnar joint (DRUJ) instability.

      Methods

      Sixty patients with triangular fibrocartilage complex foveal detachment associated with DRUJ instability were prospectively recruited and randomized into 2 equal groups—the anchor repair group and the transosseous repair group. The primary outcome was DRUJ function after 2 years, which was assessed by the DRUJ evaluating system. The secondary outcomes were grip strength, visual analog scale for pain, Mayo Modified Wrist ScorePatient-Rated Wrist Evaluation score, and the Disabilities of the Arm, Shoulder, and Hand score.

      Results

      There were no significant differences between the groups for any of the outcome measures. Good-to-excellent outcomes (according to the DRUJ evaluation system) were achieved in 27 (90%) patients in the anchor repair group and 26 (86.7%) patients in the transosseous repair group. Fewer complications were observed in the anchor repair group.

      Conclusions

      Both techniques yielded good and comparable outcomes with a lesser incidence of early complications in the anchor repair group.

      Type of study/level of evidence

      Therapeutic II.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Atzei A.
        New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability.
        J Hand Surg Eur Vol. 2009; 34: 582-591
        • Atzei A.
        • Rizzo A.
        • Luchetti R.
        • Fairplay T.
        Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability.
        Tech Hand Up Extrem Surg. 2008; 12: 226-235
        • Palmer A.K.
        Triangular fibrocartilage complex lesions: a classification.
        J Hand Surg Am. 1989; 14: 594-606
        • Nakamura T.
        • Nakao Y.
        • Ikegami H.
        • Sato K.
        • Takayama S.
        Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique.
        Tech Hand Up Extrem Surg. 2004; 8: 116-123
        • Nakamura T.
        • Sato K.
        • Okazaki M.
        • Toyama Y.
        • Ikegami H.
        Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques.
        Hand Clin. 2011; 27: 281-290
        • Luchetti R.
        • Atzei A.
        • Cozzolino R.
        • Fairplay T.
        • Badur N.
        Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.
        J Hand Surg Eur Vol. 2014; 39: 845-855
        • Atzei A.
        • Luchetti R.
        • Braidotti F.
        Arthroscopic foveal repair of the triangular fibrocartilage complex.
        J Wrist Surg. 2015; 4: 22-30
        • Iwasaki N.
        • Minami A.
        Arthroscopically assisted reattachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head.
        J Hand Surg Am. 2009; 34: 1323-1326
        • Moritomo H.
        • Masatomi T.
        • Murase T.
        • Miyake J.
        • Okada K.
        • Yoshikawa H.
        Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism.
        J Hand Surg Am. 2010; 35: 1955-1963
        • Garcia-Elias M.
        • Smith D.E.
        • Llusá M.
        Surgical approach to the triangular fibrocartilage complex.
        Techn Hand Up Extrem Surg. 2003; 7: 134-140
        • Kleinman W.B.
        Stability of the distal radioulnar joint: biomechanics, pathophysiology, physical diagnosis and restoration of function. What we have learned in 25 years.
        J Hand Surg Am. 2007; 32: 1087-1106
        • Estrella E.P.
        • Hung L.K.
        • Ho P.C.
        • Tse W.L.
        Arthroscopic repair of triangular fibrocartilage complex tears.
        Arthroscopy. 2007; 23 (737.e1): 729-737
        • Anderson M.L.
        • Larson A.N.
        • Moran S.L.
        • Cooney W.P.
        • Amrami K.K.
        • Berger R.A.
        Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears.
        J Hand Surg Am. 2008; 33: 675-682
        • Desai M.J.
        • Hutton W.C.
        • Jarrett C.D.
        Arthroscopic repair of triangular fibrocartilage tears: a biomechanical comparison of a knotless suture anchor and the traditional outside-in repairs.
        J Hand Surg Am. 2013; 38: 2193-2197
        • Gutiérrez-Monclus R.
        • Ferreres A.
        • Rodríguez-Baeza A.
        • Gutiérrez-Espinoza H.
        Arthroscopic triangular fibrocartilage complex repair: a biomechanical comparison of anchor and pull-out techniques in Atzei type II lesions.
        Sci Prog. 2021; 104368504211000888
        • Huang J.I.
        • Hanel D.P.
        Anatomy and biomechanics of the distal radioulnar joint.
        Hand Clin. 2012; 28: 157-163
        • Hawker G.A.
        • Mian S.
        • Kendzerska T.
        • French M.
        Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP).
        Arthritis Care Res. 2011; 63: S240-S252
        • Cooney W.P.
        • Bussey R.
        • Dobyns J.H.
        • Linscheid R.L.
        Difficult wrist fractures. Perilunate fracture-dislocations of the wrist.
        Clin Orthop Relat Res. 1987; 214: 136-147
        • MacDermid J.C.
        • Turgeon T.
        • Richards R.S.
        • Beadle M.
        • Roth J.H.
        Patient rating of wrist pain and disability: a reliable and valid measurement tool.
        J Orthop Trauma. 1998; 12: 577-586
        • Hudak P.L.
        • Amadio P.C.
        • 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: 602-608
        • Harris J.D.
        • Brand J.C.
        • Cote M.P.
        • Faucett S.C.
        • Dhawan A.
        Research pearls: the significance of statistics and perils of pooling. Part 1: Clinical versus statistical significance.
        Arthroscopy. 2017; 33: 1102-1112
        • Sorensen A.A.
        • Howard D.
        • Tan W.H.
        • Ketchersid J.
        • Calfee R.P.
        Minimal clinically important differences of 3 patient-rated outcomes instruments.
        J Hand Surg Am. 2013; 38: 641-649
        • Kim J.K.
        • Park E.S.
        Comparative responsiveness and minimal clinically important differences for idiopathic ulnar impaction syndrome.
        Clin Orthop Relat Res. 2013; 471: 1406-1411
        • Shinohara T.
        • Tatebe M.
        • Okui N.
        • Yamamoto M.
        • Kurimoto S.
        • Hirata H.
        Arthroscopically assisted repair of triangular fibrocartilage complex foveal tears.
        J Hand Surg Am. 2013; 38: 271-277
        • Chou K.H.
        • Sarris I.K.
        • Sotereanos D.G.
        Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears.
        J Hand Surg Br. 2003; 28: 546-550
        • Thalhammer G.
        • Haider T.
        • Lauffer M.
        • Tünnerhoff H.G.
        Mid- and long-term outcome after arthroscopically assisted transosseous triangular fibrocartilage complex refixation-good to excellent results in spite of some loss of stability of the distal radioulnar joint.
        Arthroscopy. 2021; 37: 1458-1466
        • Hermansdorfer J.D.
        • Kleinman W.B.
        Management of chronic peripheral tears of the triangular fibrocartilage complex.
        J Hand Surg Am. 1991; 16: 340-346
        • Kim B.
        • Yoon H.K.
        • Nho J.H.
        • et al.
        Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient.
        Arthroscopy. 2013; 29: 1762-1768