Results of Arthroscopic Ligamentoplasty of the Triangular Fibrocartilage Complex Using the Carratalá Technique
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Published:
Dec 26, 2024
Keywords:
Wrist arthroscopy, Atzei 4, triangular fibrocartilage complex, chronic lesion
Main Article Content
Abstract
Objective: To present the outcomes of reconstructing the triangular fibrocartilage complex (TFCC) in Atzei Type 4 chronic lesions through arthroscopic reconstruction using the Carratalá technique and a palmaris longus graft.
Materials and Methods: We retrospectively evaluated nine patients with Atzei Type 4 TFCC lesions, including six male and three female patients. All lesions were reconstructed arthroscopically with a free graft of the palmaris longus tendon, secured with radial and ulnar fixation using the Carratalá technique. We assessed range of motion (ROM), grip strength, the Mayo wrist score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.
Results: Pain and strength tests results improved in the 9 patients, in an average follow-up of 14 months. All of the patients worked. The average ROM was 80° for both extension and flexion, with a pronation-supination range of 160°. The Mayo wrist score was excellent in 78% of cases, good in 11%, and poor in 11%. The DASH score improved from an average of 61 points preoperatively to 9 points at 14 months postoperatively. The average comparative contralateral grip strength was 85%.
Conclusions: Arthroscopic reconstruction of the TFCC in Atzei Type 4 chronic lesions using the Carratalá ligamentoplasty for distal radioulnar stability is a minimally invasive and replicable technique that yields favorable functional outcomes.
Materials and Methods: We retrospectively evaluated nine patients with Atzei Type 4 TFCC lesions, including six male and three female patients. All lesions were reconstructed arthroscopically with a free graft of the palmaris longus tendon, secured with radial and ulnar fixation using the Carratalá technique. We assessed range of motion (ROM), grip strength, the Mayo wrist score, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.
Results: Pain and strength tests results improved in the 9 patients, in an average follow-up of 14 months. All of the patients worked. The average ROM was 80° for both extension and flexion, with a pronation-supination range of 160°. The Mayo wrist score was excellent in 78% of cases, good in 11%, and poor in 11%. The DASH score improved from an average of 61 points preoperatively to 9 points at 14 months postoperatively. The average comparative contralateral grip strength was 85%.
Conclusions: Arthroscopic reconstruction of the TFCC in Atzei Type 4 chronic lesions using the Carratalá ligamentoplasty for distal radioulnar stability is a minimally invasive and replicable technique that yields favorable functional outcomes.
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How to Cite
Sala, J. M., Ledesma, A. D., Galván, LuisE., & Silva Martínez , J. (2024). Results of Arthroscopic Ligamentoplasty of the Triangular Fibrocartilage Complex Using the Carratalá Technique. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(6), 573-583. https://doi.org/10.15417/issn.1852-7434.2024.89.6.1984
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Clinical Research
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References
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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
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https://doi.org/10.1016/j.hcl.2011.05.014
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https://doi.org/10.1097/00006534-197907000-00095
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human triangular fibrocartilage complex. Arch Orthop Trauma Surg 2021;141(4):699-708.
https://doi.org/10.1007/s00402-021-03795-2
8. 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
9. Ruch DS, Anderson SR, Ritter MR. Biomechanical comparison of transosseous and capsular repair of peripheral
triangular fibrocartilage tears. Arthroscopy 2003;19(4):391-6. https://doi.org/10.1053/jars.2003.50137
10. Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018;5(1):1-10. https://doi.org/10.1186/s40634-018-0120-1
11. Mathoulin CL. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol 2017;42(6):551-66. https://doi.org/10.1177/1753193417708980
12. Atzei A, Luchetti R, Braidotti F. Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg
2015;4(1):22-30. https://doi.org/10.1055/s-0035-1544226
13. Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal
radioulnar joint instability. J Hand Surg Am 2002;27(2):243-51. https://doi.org/10.1053/jhsu.2002.31731
14. Carratalá V, Lucas FJ, Miranda I, Martínez C, Guisasola E. All-arthroscopic triangular fibrocartilage complex
ligamentoplasty: technique and results. J Wrist Surg 2022;12(2):104-12. https://doi.org/10.1055/s-0042-1757765
15. Luchetti R, Khanchandani P, Da Rin F, Borelli PP, Mathoulin C, Atzei A. Arthroscopically assisted Sauvé-Kapandji procedure: An advanced technique for distal radioulnar joint arthritis. Tech Hand Up Extrem Surg 2008;12(4):216-20. https://doi.org/10.1097/BTH.0b013e31818ee28a
16. Lindsay TAJ. Ligamentization and remnant integration: review and analysis of current evidence and implications for scapholunate reconstruction. J Wrist Surg 2020;10(6):476-83. https://doi.org/10.1055/s-0040-1716863
17. Liu B, Fok MWM. The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal
reconstruction using tendon graft. Int Orthop 2021;45(5):1273-9. https://doi.org/10.1007/s00264-021-04976-9
18. Zhang W, Hou P, Wang C, Wu T, Ho PC, Sun L. Arthroscopic one-tunnel transosseous reconstruction of chronic
triangular fibrocartilage complex foveal tears: outcomes in 12 patients. J Hand Surg Eur Vol 2022;47(3):296-301.
https://doi.org/10.1177/17531934211056854
triangular fibrocartilage complex and related osseous landmarks. J Hand Surg Am 2021;46(7):625.e1-625.e7.
https://doi.org/10.1016/j.jhsa.2020.12.006
2. Chu-Kay Mak M, Ho PC. Arthroscopic-assisted triangular fibrocartilage complex reconstruction. Hand Clin
2017;33(4):625-37. https://doi.org/10.1016/j.hcl.2017.07.014
3. 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
4. Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin 2011;27(3):263-72.
https://doi.org/10.1016/j.hcl.2011.05.014
5. Fischer J, Thompson NW, Harrison JWK. Triangular fibrocartilage complex lesions-A classification. En:
Banaszkiewicz P, Kader D. Classic papers in orthopaedics. London: Springer; 2014, pág. 371-2.
https://doi.org/10.1007/978-1-4471-5451-8_93
6. Zook EG. Age changes in the triangular fibrocartilage of the wrist joint. Plast Reconstr Surg 1979;64(1):128.
https://doi.org/10.1097/00006534-197907000-00095
7. Rein S, Krenn V, Hagert E, García-Elias M, Lluch A, Kremer T, et al. Degeneration of the articular disc in the
human triangular fibrocartilage complex. Arch Orthop Trauma Surg 2021;141(4):699-708.
https://doi.org/10.1007/s00402-021-03795-2
8. 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
9. Ruch DS, Anderson SR, Ritter MR. Biomechanical comparison of transosseous and capsular repair of peripheral
triangular fibrocartilage tears. Arthroscopy 2003;19(4):391-6. https://doi.org/10.1053/jars.2003.50137
10. Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018;5(1):1-10. https://doi.org/10.1186/s40634-018-0120-1
11. Mathoulin CL. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol 2017;42(6):551-66. https://doi.org/10.1177/1753193417708980
12. Atzei A, Luchetti R, Braidotti F. Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg
2015;4(1):22-30. https://doi.org/10.1055/s-0035-1544226
13. Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal
radioulnar joint instability. J Hand Surg Am 2002;27(2):243-51. https://doi.org/10.1053/jhsu.2002.31731
14. Carratalá V, Lucas FJ, Miranda I, Martínez C, Guisasola E. All-arthroscopic triangular fibrocartilage complex
ligamentoplasty: technique and results. J Wrist Surg 2022;12(2):104-12. https://doi.org/10.1055/s-0042-1757765
15. Luchetti R, Khanchandani P, Da Rin F, Borelli PP, Mathoulin C, Atzei A. Arthroscopically assisted Sauvé-Kapandji procedure: An advanced technique for distal radioulnar joint arthritis. Tech Hand Up Extrem Surg 2008;12(4):216-20. https://doi.org/10.1097/BTH.0b013e31818ee28a
16. Lindsay TAJ. Ligamentization and remnant integration: review and analysis of current evidence and implications for scapholunate reconstruction. J Wrist Surg 2020;10(6):476-83. https://doi.org/10.1055/s-0040-1716863
17. Liu B, Fok MWM. The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal
reconstruction using tendon graft. Int Orthop 2021;45(5):1273-9. https://doi.org/10.1007/s00264-021-04976-9
18. Zhang W, Hou P, Wang C, Wu T, Ho PC, Sun L. Arthroscopic one-tunnel transosseous reconstruction of chronic
triangular fibrocartilage complex foveal tears: outcomes in 12 patients. J Hand Surg Eur Vol 2022;47(3):296-301.
https://doi.org/10.1177/17531934211056854