Abstract
Purpose
In patients with symptomatic chronic distal radio-ulnar joint (DRUJ) instability with
irreparable triangular fibrocartilage complex (TFCC), reconstruction with a tendon
graft is indicated. We performed a follow-up study with a minimum 32-month follow-up
in a bid to propose an arthroscopic TFCC anatomical reconstruction technique using
a single limb of tendon graft as a viable option for patients with irreparable TFCC
and chronic symptomatic DRUJ instability.
Materials and Methods
Between 2015 and 2021, eight (four females, four males) patients with an average age
of 29.5 years underwent this novel technique. Standard wrist arthroscopy portals were
used. The palmaris longus was harvested with one end fashioned into an oblong-shaped
tendon ball and secured with sutures. A bone tunnel was created at the metaphyseal
region of the distal ulnar in the direction of the center of the fovea. The free end
of the tendon graft was fed through the 6R portal and pulled via this bone tunnel
to restore the foveal footprint. The wrist range of motion (ROM), grip strength, Patient-Rated
Wrist Evaluation (PRWE), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH),
and Mayo Wrist Score (MWS) were used for evaluation pre-surgery and at follow-up.
Results
At a minimum follow-up of 32 months (mean 77.5 months, range 32–105 months), DRUJ
was stable in all patients. Comparing pre- and postoperative data, there was improvement
with significant p-values in grip strength as compared with contralateral wrist (84 to 107%), PRWE (34.5
to 4.3), Q-DASH (28.2 to 3.4), and MWS (75 to 95). The average duration of the operation
was 69.3 minutes (range 52–95 minutes).
Conclusion
TFCC foveal reconstruction using a single limb of tendon graft is a viable arthroscopic
technique in patients with symptomatic chronic DRUJ instability and irreparable TFCC.
Level of Evidence
Level IV, Therapeutic.
Keywords
triangular fibrocartilage complex (TFCC) - distal radio-ulnar joint instability (DRUJ
instability) - fovea reconstruction - tendon graft - wrist arthroscopy
