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J Wrist Surg
DOI: 10.1055/a-2523-2427
Scientific Article

Comparative Study of Immobilization Protocols after Arthroscopic Suture of Peripheral and Foveal TFCC Injuries: A Cohort Study of 387 Patients

Benjamin Dufournier
1   International Wrist Center, Bizet Clinic, Paris, France
2   University of Paris-Saclay, Inserm CESP Team MOODS, Le Kremlin Bicetre, France
3   Department of Geriatric, Assistance Publisque – Hôpitaux de Paris, Paul Brousse Hospital, Villejuif, France
,
Edouard Baudouin
2   University of Paris-Saclay, Inserm CESP Team MOODS, Le Kremlin Bicetre, France
3   Department of Geriatric, Assistance Publisque – Hôpitaux de Paris, Paul Brousse Hospital, Villejuif, France
,
Christophe Mathoulin
1   International Wrist Center, Bizet Clinic, Paris, France
,
Mathilde Gras
1   International Wrist Center, Bizet Clinic, Paris, France
,
Ahlam Arnaout
1   International Wrist Center, Bizet Clinic, Paris, France
,
Jean-Baptiste de Villeneuve Bargemon 
1   International Wrist Center, Bizet Clinic, Paris, France
4   Hand Surgery and Limb Reconstructive Surgery Department, La Timone Adult Hospital, Aix Marseille University, Marseille, France
5   Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
,
Lorenzo Merlini
1   International Wrist Center, Bizet Clinic, Paris, France
› Author Affiliations
Funding None.
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Abstract

Introduction The triangular fibrocartilage complex (TFCC) is the main stabilizer of the distal radio-ulnar joint. There is a wide disparity in postoperative immobilization after arthroscopic suturing of the TFCC. Moreover, there are no studies focused specifically on the subject.

Hypothesis Because of its effect on pronosupination, we can ask ourselves whether immobilization of the elbow (during part or all of the immobilization) after arthroscopic suture of the TFCC is necessary.

Materials and Methods We performed a single-center, retrospective, comparative study with an inclusion period of January 2015 to December 2021. The lesions were classified according to the Atzei classification with peripheral or foveal lesions. Patients were divided into three groups based on postoperative immobilization. We compared the postoperative results of arthroscopic suturing of the TFCC of peripheral and proximal lesions according to three methods of immobilization (6 weeks wrist immobilization [group 1]), 3 weeks wrist and elbow immobilization then 3 weeks wrist immobilization [group 2], and 6 weeks wrist and elbow immobilization [group 3]). The primary outcome was the QuickDASH (disabilities of the arm, shoulder, and hand), and as secondary outcomes, range of motion (°), grip strength (kg), pain (numeric rating scale [NRS]), the presence of distal radioulnar joint (DRUJ) instability, and postoperative complications were analyzed. After the operation, the patients were systematically followed up at 3 months, 6 months, and 1 year. The data collected are at 1 year of postoperative follow-up.

Results We included 387 patients in our study, with an average age of 32.6 years. A total of 302 peripheral lesions and 85 foveal lesions were included. Concerning the “peripheral” population, the difference in the QuickDASH was significantly different between the three groups with a greater improvement in group 2. Group 2 differed from the others in having less postoperative pain but less recovery of grip strength and flexion. Concerning the “foveal” population, the difference in the QuickDASH was significantly different between the three groups, with a greater improvement in group 1 with lower pain in this group.

Discussion With the results of this study, we propose to carry out an immobilization of 3 weeks wrist and elbow then 3 weeks only wrist for the peripheral lesions, and an immobilization 6 weeks of the pronosupination for the foveal lesions of TFCC.

Level of Evidence IV.

Keywords

wrist - arthroscopy - triangular fibrocartilaginous complex - carpus - cast


Publication History

Received: 26 October 2024

Accepted: 20 January 2025

Article published online:
24 February 2025

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