Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair
21 January 2019
09 April 2019
27 May 2019 (eFirst)
Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results.
Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs.
Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient.
Results Eleven patients (mean age, 36 years; range, 20–64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3–10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention.
Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears.
Level of Evidence This is a Level IV, therapeutic study.
Ethical Review Committee Statement
IRB approved (Protocol 33895).
- 1 Kleinman WB. Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 2007; 32 (07) 1086-1106
- 2 Palmer AK, Glisson RR, Werner FW. Relationship between ulnar variance and triangular fibrocartilage complex thickness. J Hand Surg Am 1984; 9 (05) 681-682
- 3 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist--anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
- 4 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 5 Palmer AK, Werner FW, Glisson RR, Murphy DJ. Partial excision of the triangular fibrocartilage complex. J Hand Surg Am 1988; 13 (03) 391-394
- 6 Palmer AK. Triangular fibrocartilage disorders: injury patterns and treatment. Arthroscopy 1990; 6 (02) 125-132
- 7 Haugstvedt J-R, Berger RA, Nakamura T, Neale P, Berglund L, An K-N. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 2006; 31 (03) 445-451
- 8 Bednar MS, Arnoczky SP, Weiland AJ. The microvasculature of the triangular fibrocartilage complex: its clinical significance. J Hand Surg Am 1991; 16 (06) 1101-1105
- 9 Park MJ, Jagadish A, Yao J. The rate of triangular fibrocartilage injuries requiring surgical intervention. Orthopedics 2010; 33 (11) 806
- 10 Adams BD, Leversedge FJ. Distal Radioulnar Joint. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. , eds. Green's Operative Hand Surgery, 7th ed. Philadelphia, PA: Elsevier, Inc.; 2017: 479-515
- 11 Wysocki RW, Richard MJ, Crowe MM, Leversedge FJ, Ruch DS. Arthroscopic treatment of peripheral triangular fibrocartilage complex tears with the deep fibers intact. J Hand Surg Am 2012; 37 (03) 509-516
- 12 Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018; 5 (01) 6
- 13 Whipple TL, Geissler WB. Arthroscopic management of wrist triangular fibrocartilage complex injuries in the athlete. Orthopedics 1993; 16 (09) 1061-1067
- 14 Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins N. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy 1997; 13 (01) 78-84
- 15 Estrella EP, Hung L-K, Ho P-C, Tse WL. Arthroscopic repair of triangular fibrocartilage complex tears. Arthroscopy 2007; 23 (07) 729-737 , 737.e1
- 16 Pederzini LA, Tosi M, Prandini M, Botticella C. All-inside suture technique for Palmer class 1B triangular fibrocartilage repair. Arthroscopy 2007; 23 (10) 1130.e1-1130.e4
- 17 Yao J. All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clin 2011; 27 (03) 237-242
- 18 Haugstvedt JR, Søreide E. Arthroscopic management of triangular fibrocartilage complex peripheral injury. Hand Clin 2017; 33 (04) 607-618
- 19 Soreide E, Husby T, Haugstvedt JR. A long-term (20 years') follow-up after arthroscopically assisted repair of the TFCC. J Plast Surg Hand Surg 2017; 51 (05) 296-300
- 20 Yao J, Dantuluri P, Osterman AL. A novel technique of all-inside arthroscopic triangular fibrocartilage complex repair. Arthroscopy 2007; 23 (12) 1357.e1-1357.e4
- 21 Yao J. All-arthroscopic triangular fibrocartilage complex repair: safety and biomechanical comparison with a traditional outside-in technique in cadavers. J Hand Surg Am 2009; 34 (04) 671-676
- 22 Yao J, Lee AT. All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. J Hand Surg Am 2011; 36 (05) 836-842
- 23 Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011; 27 (03) 263-272
- 24 Nikiphorou E, Radner H, Chatzidionysiou K. , et al. Patient global assessment in measuring disease activity in rheumatoid arthritis: a review of the literature. Arthritis Res Ther 2016; 18 (01) 251
- 25 Strauss NL, Goldfarb CA. Arthroscopic management of traumatic peripheral triangular fibrocartilage complex tears. J Hand Surg Am 2011; 36 (01) 136-138
- 26 Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA. Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 2008; 33 (05) 675-682
- 27 Reiter A, Wolf MB, Schmid U. , et al. Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy 2008; 24 (11) 1244-1250
- 28 Bayoumy MA, Elkady HA, Said HG, El-Sayed A, Saleh WR. Short-term evaluation of arthroscopic outside-in repair of ulnar side TFCC tear with vertical mattress suture. J Orthop 2015; 13 (04) 455-460
- 29 Trumble TE, Gilbert M, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg Am 1997; 22 (01) 57-65
- 30 Wolf MB, Haas A, Dragu A. , et al. Arthroscopic repair of ulnar-sided triangular fibrocartilage complex (Palmer Type 1B) tears: a comparison between short- and midterm results. J Hand Surg Am 2012; 37 (11) 2325-2330
- 31 Slutsky DJ. Outcomes assessment in wrist surgery. J Wrist Surg 2013; 2 (01) 1-4
- 32 Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am 2002; 84-A (02) 208-215
- 33 Ruch DS, Papadonikolakis A. Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome. Arthroscopy 2005; 21 (09) 1126-1130
- 34 Badia A, Khanchandani P. Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears. Tech Hand Up Extrem Surg 2007; 11 (01) 45-50
- 35 Shih J-T, Lee H-M, Tan C-M. Early isolated triangular fibrocartilage complex tears: management by arthroscopic repair. J Trauma 2002; 53 (05) 922-927
- 36 Haugstvedt JR, Husby T. Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (04) 439-447
- 37 Böhringer G, Schädel-Höpfner M, Petermann J, Gotzen L. A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears. Arthroscopy 2002; 18 (02) 211-213
- 38 Conca M, Conca R, Dalla Pria A. Preliminary experience of fully arthroscopic repair of triangular fibrocartilage complex lesions. Arthroscopy 2004; 20 (07) e79-e82
- 39 Lee CK, Cho HL, Jung KA, Jo JY, Ku JH. Arthroscopic all-inside repair of Palmer type 1B triangular fibrocartilage complex tears: a technical note. Knee Surg Sports Traumatol Arthrosc 2008; 16 (01) 94-97
- 40 del Piñal F, García-Bernal FJ, Cagigal L, Studer A, Regalado J, Thams C. A technique for arthroscopic all-inside suturing in the wrist. J Hand Surg Eur Vol 2010; 35 (06) 475-479
- 41 Millants P, De Smet L, Van Ransbeeck H. Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist. Chir Main 2002; 21 (05) 298-300
- 42 Waterman SM, Slade D, Masini BD, Owens BD. Safety analysis of all-inside arthroscopic repair of peripheral triangular fibrocartilage complex. Arthroscopy 2010; 26 (11) 1474-1477
- 43 Kuremsky MA, Habet N, Peindl RD, Gaston RG. Proximity of the triangular fibrocartilage complex to key surrounding structures and safety assessment of an arthroscopic repair technique: a cadaveric study. Arthroscopy 2016; 32 (12) 2490-2494