Mid- and Long-Term Outcome After Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Refixation-Good to Excellent Results in Spite of Some Loss of Stability of the Distal Radioulnar Joint

Arthroscopy. 2021 May;37(5):1458-1466. doi: 10.1016/j.arthro.2021.01.056. Epub 2021 Feb 6.

Abstract

Purpose: To evaluate mid- and long-term outcomes after arthroscopically-assisted transosseous reattachment of the triangular fibrocartilage complex (TFCC) and to analyze the association of distal radioulnar joint (DRUJ) stability with the clinical outcome.

Methods: Patients treated with an arthroscopically-assisted transosseous reattachment of the deep layer of the TFCC between 2000 and 2009 and a minimum follow-up of 12 months at mid-term and 4 years at long-term follow-up were retrospectively reviewed. Mayo Modified Wrist Score (MMWS); Disabilities of the Arm, Shoulder and Hand (DASH) score; pain visual analogue scale (VAS); grip strength and stability of the DRUJ were assessed at 2 follow-up clinical examinations. At the last follow-up, the Patient-Rated Wrist Evaluation score was additionally recorded.

Results: Thirty patients with a mean age of 29 (±13) years were included. Most of the patients were female (70%, n = 21). The mid-term evaluation took place at a median of 30 months (range, 12-83 months). The assessed scores showed statistically significant clinical improvement (MMWS, P < .001; DASH score P < .001; VAS P < .001). Stability assessment showed a stable DRUJ in 23 (76.7%) patients. At a median of 106 months (range 52-215 months), the long-term clinical assessment was performed. The evaluated scores demonstrated persisting significant improvement (MMWS P < .001; DASH score P < .001; VAS P < .001). Stability assessment showed a stable DRUJ in 19 patients (63.3%). DRUJ instability did not correlate with clinical outcome. No permanent surgery-related complications occurred.

Conclusion: Arthroscopically-assisted transosseous reattachment of the deep fibers of radioulnar ligaments leads to excellent and good clinical results in mid- and long-term follow-up. In 95.5% of the analyzed patients, the measured improvement in the DASH score exceeded the in literature reported minimal clinically important difference of 13.5. Loss of DRUJ stability during follow-up was not associated with deterioration of clinical parameters and patient satisfaction.

Level of evidence: Level IV, retrospective case series.

MeSH terms

  • Adolescent
  • Adult
  • Arthroscopy*
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Instability / physiopathology
  • Joint Instability / surgery*
  • Male
  • Middle Aged
  • Minimal Clinically Important Difference
  • Pain Measurement
  • Patient Satisfaction
  • Radius / physiopathology
  • Radius / surgery*
  • Range of Motion, Articular
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome
  • Triangular Fibrocartilage / physiopathology
  • Triangular Fibrocartilage / surgery*
  • Ulna / physiopathology
  • Ulna / surgery*
  • Visual Analog Scale
  • Wrist Joint / physiopathology
  • Wrist Joint / surgery*
  • Young Adult