Results of the Knotless Arthroscopic Foveal Anchorage of the Triangular Fibrocartilage Complex in Atzei 2/3 Lesions
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Published:
Oct 10, 2021
Keywords:
Wrist arthroscopy, Atzei 2, Atzei 3, triangular fibrocartilage complex, knotless bone anchorage
Main Article Content
Abstract
Objective: To retrospectively evaluate the functional and objective outcomes in patients with foveal lesions of the triangular fibrocartilage complex treated with arthroscopic knotless bone anchors.
Materials and Methods: We retrospectively evaluated 12 patients with Atzei 2/3 foveal lesions of the triangular fibrocartilage complex with an average follow-up of 18 months. All the lesions were repaired arthroscopically using a fibrocartilage guide and knotless bone anchors. The ranges of motion and grip strength were assessed with the Mayo Clinic wrist scale and the DASH questionnaire.
Results: Improvements were obtained in the pain and strength test; the average range of motion was 70° in extension, 85° in flexion, 20° in radial deviation, and 30° in ulnar deviation. The outcomes according to the Mayo Clinic wrist scale were excellent in 83% of the cases and good in 17%; there were no poor outcomes. The average DASH score was 56 preoperatively and 8 postoperatively. The average contralateral comparative strength was 70%.
Conclusion: The arthroscopic repair of Atzei 2/3 lesions with knotless bone anchors achieves good outcomes,improves ranges of motion, and restores stability and total or partial strength in all cases.
Materials and Methods: We retrospectively evaluated 12 patients with Atzei 2/3 foveal lesions of the triangular fibrocartilage complex with an average follow-up of 18 months. All the lesions were repaired arthroscopically using a fibrocartilage guide and knotless bone anchors. The ranges of motion and grip strength were assessed with the Mayo Clinic wrist scale and the DASH questionnaire.
Results: Improvements were obtained in the pain and strength test; the average range of motion was 70° in extension, 85° in flexion, 20° in radial deviation, and 30° in ulnar deviation. The outcomes according to the Mayo Clinic wrist scale were excellent in 83% of the cases and good in 17%; there were no poor outcomes. The average DASH score was 56 preoperatively and 8 postoperatively. The average contralateral comparative strength was 70%.
Conclusion: The arthroscopic repair of Atzei 2/3 lesions with knotless bone anchors achieves good outcomes,improves ranges of motion, and restores stability and total or partial strength in all cases.
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How to Cite
Sala , M., & Daroda, S. (2021). Results of the Knotless Arthroscopic Foveal Anchorage of the Triangular Fibrocartilage Complex in Atzei 2/3 Lesions. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 86(5), 581-594. https://doi.org/10.15417/issn.1852-7434.2021.86.5.1374
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Clinical Research
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References
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2015;4:22-30. https://doi.org/10.1055/s-0035-1544226
2. Trehan SK, Wall LB, Calfee RP, Shen TS, Dy CJ, Yannascoli SM, et al. Arthroscopic diagnosis of the triangular
fibrocartilage complex foveal tear: a cadaver assessment. J Hand Surg Am 2018;43(7):680.e1-680.e5.
https://doi.org/10.1016/j.jhsa.2017.12.017
3. Ma CH, Lin TS, Wu CH, Li DY, Yang SC, Tu YK. Biomechanical comparison of open and arthroscopic transosseous repair of triangular fibrocartilage complex foveal tears: a cadaveric study. Arthroscopy 2017;33(2):297-304. https://doi.org/10.1016/j.arthro.2016.10.027
4. Hong Li, Yujie Zhao, Yinghui Hua, Qianru Li, Hongyun Li, Shiyi Chen. Knotless anchor repair produced similar
favourable outcomes as knot anchor repair for anterior talofibular ligament repair. Knee Surg Sports Traumatol
Arthosc 2020;28(12):3987-93. https://doi.org/10.1007/s00167-020-05998-3
5. Lacheta L, Dekker TJ, Anderson N, Goldenberg B, Millett PJ. Arthroscopic knotless, tensionable all-suture anchor Bankart repair. Arthrosc Technic 2019;8(6):e647-e653. https://doi.org/10.1016/j.eats.2019.02.010
6. Palmer AK. Triangular fibrocartilage complex lesions: a classification. Hand Surg Am1989;14(4):594-606.
https://doi.org/10.1016/0363-5023(89)90174-3
7. 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(2):271-7. https://doi.org/10.1016/j.hsa.2012.11.008
8. Jung HS, Song KS, Jung HS, Yoon BI, Lee JS, Park MJ. Clinical outcomes and factors influencing these outcome
measures resulting in success after arthroscopic transosseous triangular fibrocartilage complex foveal repair.
Arthroscopy 2019;35(8):2322-30. https://doi.org/10.1016/j.arthro.2019.03.060
9. Park JH, Kim D, Park JW. Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear. Arch Orthop Trauma Surg 2018;138(1):131-8. https://doi.org/10.1007/s00402-017-2835-3
10. Geissler WB. Management of scapholunate instability. En: Geissler WB (ed). Wrist arthroscopy. New York:
Springer; 2005:86-93.
11. De Smet L. The DASH questionnaire and score in the evaluation of hand and wrist disorders. Acta Orthop Belg 2008;74(5):575-81. PMID: 19058688
12. Cáceres-Palou E, López-Prats F, Mesa-Ramos M, et al. Valoración de resultados en Cirugía Ortopédica y
Traumatología. Rev Esp Cir Ortop Traumatol 2005;49(S1):119-42. Disponible en: https://www.elsevier.es/enrevista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-valoracion-resultados-cirugia-ortopedicatraumatologia-X1888441505011090
13. DaSilva MF, Goodman AD, Gil JA, Akelman EJ. Evaluation of ulnar-sided wrist pain. Am Acad Orthop Surg
2017;25(8):e150-e156. https://doi.org/10.5435/JAAOS-D-16-00407
14. Matsumoto T, Tang P, Fujio K, Strauch RJ, Rosenwasser MP. The optimal suture placement and bone tunnels for TFCC repair: a cadaveric study. J Wrist Surg 2018;7(5):375-81. https://doi.org/10.1055/s-0038-1661361
15. Chen WJ. Arthroscopically assisted transosseous foveal repair of triangular fibrocartilage complex. Arthrosc Tech 2017;6(1):e57-e64. https://doi.org/10.1016/j.eats.2016.09.004
2015;4:22-30. https://doi.org/10.1055/s-0035-1544226
2. Trehan SK, Wall LB, Calfee RP, Shen TS, Dy CJ, Yannascoli SM, et al. Arthroscopic diagnosis of the triangular
fibrocartilage complex foveal tear: a cadaver assessment. J Hand Surg Am 2018;43(7):680.e1-680.e5.
https://doi.org/10.1016/j.jhsa.2017.12.017
3. Ma CH, Lin TS, Wu CH, Li DY, Yang SC, Tu YK. Biomechanical comparison of open and arthroscopic transosseous repair of triangular fibrocartilage complex foveal tears: a cadaveric study. Arthroscopy 2017;33(2):297-304. https://doi.org/10.1016/j.arthro.2016.10.027
4. Hong Li, Yujie Zhao, Yinghui Hua, Qianru Li, Hongyun Li, Shiyi Chen. Knotless anchor repair produced similar
favourable outcomes as knot anchor repair for anterior talofibular ligament repair. Knee Surg Sports Traumatol
Arthosc 2020;28(12):3987-93. https://doi.org/10.1007/s00167-020-05998-3
5. Lacheta L, Dekker TJ, Anderson N, Goldenberg B, Millett PJ. Arthroscopic knotless, tensionable all-suture anchor Bankart repair. Arthrosc Technic 2019;8(6):e647-e653. https://doi.org/10.1016/j.eats.2019.02.010
6. Palmer AK. Triangular fibrocartilage complex lesions: a classification. Hand Surg Am1989;14(4):594-606.
https://doi.org/10.1016/0363-5023(89)90174-3
7. 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(2):271-7. https://doi.org/10.1016/j.hsa.2012.11.008
8. Jung HS, Song KS, Jung HS, Yoon BI, Lee JS, Park MJ. Clinical outcomes and factors influencing these outcome
measures resulting in success after arthroscopic transosseous triangular fibrocartilage complex foveal repair.
Arthroscopy 2019;35(8):2322-30. https://doi.org/10.1016/j.arthro.2019.03.060
9. Park JH, Kim D, Park JW. Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear. Arch Orthop Trauma Surg 2018;138(1):131-8. https://doi.org/10.1007/s00402-017-2835-3
10. Geissler WB. Management of scapholunate instability. En: Geissler WB (ed). Wrist arthroscopy. New York:
Springer; 2005:86-93.
11. De Smet L. The DASH questionnaire and score in the evaluation of hand and wrist disorders. Acta Orthop Belg 2008;74(5):575-81. PMID: 19058688
12. Cáceres-Palou E, López-Prats F, Mesa-Ramos M, et al. Valoración de resultados en Cirugía Ortopédica y
Traumatología. Rev Esp Cir Ortop Traumatol 2005;49(S1):119-42. Disponible en: https://www.elsevier.es/enrevista-revista-espanola-cirugia-ortopedica-traumatologia-129-articulo-valoracion-resultados-cirugia-ortopedicatraumatologia-X1888441505011090
13. DaSilva MF, Goodman AD, Gil JA, Akelman EJ. Evaluation of ulnar-sided wrist pain. Am Acad Orthop Surg
2017;25(8):e150-e156. https://doi.org/10.5435/JAAOS-D-16-00407
14. Matsumoto T, Tang P, Fujio K, Strauch RJ, Rosenwasser MP. The optimal suture placement and bone tunnels for TFCC repair: a cadaveric study. J Wrist Surg 2018;7(5):375-81. https://doi.org/10.1055/s-0038-1661361
15. Chen WJ. Arthroscopically assisted transosseous foveal repair of triangular fibrocartilage complex. Arthrosc Tech 2017;6(1):e57-e64. https://doi.org/10.1016/j.eats.2016.09.004