Early results with arthroscopic repair of peripheral tears of the triangular fibrocartilage complex (Palmer Type 1B)
Aim: Injury to the triangular fibrocartilage complex (TFCC) is one the major causes of ulnar sided wrist pain and distal radioulnar joint instability. In this study, the results of arthroscopic repair of peripheral (Palmer Type 1) TFCC tears were retrospectively analyzed.
Material and Methods: The results of eleven patients (6 males, 5 females, mean age: 27.6 years (range:19-42 yrs)) who presented with peripheral (Palmer type 1B) TFCC tears and underwent arthroscopic repair between 2008-2011 using a separate portal opened 1 cm below the 6R portal and outside-in suture technique were retrospectively analyzed. All patients had wrist pain and limited range of motion that did not respond to conservative treatment. MRI (Magnetic resonance imaging) revealed peripheral TFCC tear in all patients. Mean interval between onset of symptoms and surgery was 16.2 (range: 4-46) months, and mean follow up after surgery was 11.6 months (range:6-21 months). Functional assessment was made with “Quick DASH in Turkish” and VAS (Visual Analog Scale). Preoperative and follow up data were statistically compared.
Results: Mean Quick DASH symptom scores decreased from 20.45 (range: 9.09-38.63) before surgery to 4.33 (range: 2.27-9.09) after surgery. Mean VAS decreased from 6.53 (4.5-8.2) before surgery decreased to 1.48 (range:0.3-3.1) after surgery. The difference between the results were statistically highly significant.
Conclusion: Arthroscopy enables repair of the TFCC with minimal injury, allows better visualization and evaluation of all joint structures. The outside- in suture technique applied from a portal opened 1 cm below the 6R portal is a minimally traumatic method where injury to the superficial branch of the ulnar nerve is not a possibility. Using this technique, significant reduction in DRUJ instability and preoperative pain can be achieved.
Key words: Triangular fibrocartilage, arthroscopy, wrist injuries, wrist joint
