Anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex injury under wrist arthroscopy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Chengyin ¹ , ZHANG Hailong ² , ZHANG Laifu ¹ , WANG Pengtao ¹ ,  WANG Xiaohui ¹

1. Luoyang Pingle Bone Setting College, Henan University of Chinese Medicine, Luoyang Henan, 471002, P.R.China;
2. The 2nd Department of Sports Medicine and Arthroscopy, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;

Corresponding author：

WANG Xiaohui, Email: 963099784@qq.com

Keywords：

Wrist; arthroscopy; triangular fibrocartilage complex; anatomical repair

DOI：

10.7507/1002-1892.202104126

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex (TFCC) injury under wrist arthroscopy. Methods Between March 2018 and March 2020, 16 patients with Atzei-EWAS type 2 TFCC injury were admitted, and the TFCCs were anatomically repaired with a three-dimensional suture with a thread anchor under wrist arthroscopy. There were 10 males and 6 females with an average of 40.2 years (range, 22-54 years). The disease duration ranged from 2 to 9 months (mean, 6.4 months). Preoperative grip strength of the affected limb was (20.06±3.38) kg, wrist range of motion in flexion and extension was (117.19±7.74)°, radial-ulnar deviation was (31.25±5.32)°, forearm rotation range of motion was (137.19±14.83)°, visual analogue scale (VAS) score was 5.6±1.2. At last follow-up, the effectiveness was evaluated by the grip strength of the affected limb, the range of motion of the wrist joint, the VAS score, and the modified Mayo wrist score. Results All incisions healed by first intention. One case had paralysis of the dorsal branch of the ulnar nerve after operation, and no other complications occurred in other cases. All patients were followed up 12-18 months (mean, 14.5 months). The distal radioulnar joint stability of all patients recovered. At last follow-up, the grip strength of the affected limb was (24.88±3.26) kg, the range of motion in flexion and extension was (146.59±6.49)°, radial-ulnar deviation was (39.38±6.55)°, and forearm rotation range of motion was (152.50±11.55)°, which were significantly higher than those before operation (P<0.05); the VAS score was 0.9±0.8, which was significantly lower than that before operation (t=21.029, P=0.000). The modified Mayo wrist score was rated as excellent in 10 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 93.8%. MRI results showed that TFCC healed in all cases. Conclusion For Atzei-EWAS type 2 TFCC injury, anatomical repair under wrist arthroscopy can restore the anatomical structure of TFCC, effectively relieve wrist pain, improve function, and obtain good effectiveness.

Citation： LU Chengyin, ZHANG Hailong, ZHANG Laifu, WANG Pengtao, WANG Xiaohui. Anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex injury under wrist arthroscopy. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(11): 1417-1421. doi: 10.7507/1002-1892.202104126 Copy

1.	Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin, 2011, 27(3): 263-272.
2.	Jung HS, Kim SH, Jung CW, et al. Arthroscopic transosseous repair of foveal tears of the triangular fibrocartilage complex: a systematic review of clinical outcomes. Arthroscopy, 2021, 37(5): 1641-1650.
3.	Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer typeⅠB tears. J Hand Surg (Eur Vol), 2017, 42(4): 405-414.
4.	Park JH, Park JW. Arthroscopic transosseous repair for both proximal and distal components of peripheral triangular fibrocartilage complex tear. Indian J Orthop, 2018, 52(6): 596-601.
5.	Auzias P, Camus EJ, Moungondo F, et al. Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: clinical and radiographic outcomes at 4 years’ mean follow-up. Hand Surg Rehabil, 2020, 39(3): 193-200.
6.	Nakamura T, Sato K, Okazaki M, et al. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin, 2011, 27(3): 281-290.
7.	Liu B, Arianni M. Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsion: a novel technique. Tech Hand Up Extrem Surg, 2020, 24(4): 175-181.
8.	Trehan SK, Wall LB, Calfee RP, 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.
9.	Shin WJ, Kim JP, Yang HM, et al. Topographical anatomy of the distal ulna Attachment of the Radioulnar Ligament. J Hand Surg (Am), 2017, 42(7): 517-524.
10.	Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? J Clin Orthop Trauma, 2020, 11(4): 570-579.
11.	Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg (Am), 1981, 6(2): 153-162.
12.	Moritomo H. Open repair of the triangular fibrocartilage complex from palmar aspect. J Wrist Surg, 2015, 4(1): 2-8.
13.	Kermarrec G, Cohen G, Upex P, et al. Arthroscopic foveal reattachment of the triangular fibro cartilaginous complex. J Wrist Surg, 2020, 9(3): 256-262.
14.	Luchetti R, Atzei A, Cozzolino R, et al. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability. J Hand Surg (Eur Vol), 2014, 39(8): 845-855.
15.	魏本磊, 韩清銮, 张磊, 等. 关节镜辅助穿骨固定修复腕三角纤维软骨复合体损伤. 中国矫形外科杂志, 2020, 28(11): 918-922.
16.	Atzei A, Rizzo A, Luchetti R, et al. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg, 2008, 12(4): 226-235.
17.	Park JH, Lim JW, Kwon YW, et al. Functional outcomes are similar after early and late arthroscopic one-tunnel transosseous repair of triangular fibrocartilage complex foveal tears. Arthroscopy, 2020, 36(7): 1845-1852.
18.	张闻, 刘生和, 柴益民, 等. 腕关节镜下经骨隧道修复三角纤维软骨复合体损伤. 国际骨科学杂志, 2019, 40(6): 357-363.

1. Atzei A, Luchetti R. Foveal TFCC tear classification and treatment. Hand Clin, 2011, 27(3): 263-272.
2. Jung HS, Kim SH, Jung CW, et al. Arthroscopic transosseous repair of foveal tears of the triangular fibrocartilage complex: a systematic review of clinical outcomes. Arthroscopy, 2021, 37(5): 1641-1650.
3. Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer typeⅠB tears. J Hand Surg (Eur Vol), 2017, 42(4): 405-414.
4. Park JH, Park JW. Arthroscopic transosseous repair for both proximal and distal components of peripheral triangular fibrocartilage complex tear. Indian J Orthop, 2018, 52(6): 596-601.
5. Auzias P, Camus EJ, Moungondo F, et al. Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: clinical and radiographic outcomes at 4 years’ mean follow-up. Hand Surg Rehabil, 2020, 39(3): 193-200.
6. Nakamura T, Sato K, Okazaki M, et al. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin, 2011, 27(3): 281-290.
7. Liu B, Arianni M. Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsion: a novel technique. Tech Hand Up Extrem Surg, 2020, 24(4): 175-181.
8. Trehan SK, Wall LB, Calfee RP, 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.
9. Shin WJ, Kim JP, Yang HM, et al. Topographical anatomy of the distal ulna Attachment of the Radioulnar Ligament. J Hand Surg (Am), 2017, 42(7): 517-524.
10. Jawed A, Ansari MT, Gupta V. TFCC injuries: How we treat? J Clin Orthop Trauma, 2020, 11(4): 570-579.
11. Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist-anatomy and function. J Hand Surg (Am), 1981, 6(2): 153-162.
12. Moritomo H. Open repair of the triangular fibrocartilage complex from palmar aspect. J Wrist Surg, 2015, 4(1): 2-8.
13. Kermarrec G, Cohen G, Upex P, et al. Arthroscopic foveal reattachment of the triangular fibro cartilaginous complex. J Wrist Surg, 2020, 9(3): 256-262.
14. Luchetti R, Atzei A, Cozzolino R, et al. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability. J Hand Surg (Eur Vol), 2014, 39(8): 845-855.
15. 魏本磊, 韩清銮, 张磊, 等. 关节镜辅助穿骨固定修复腕三角纤维软骨复合体损伤. 中国矫形外科杂志, 2020, 28(11): 918-922.
16. Atzei A, Rizzo A, Luchetti R, et al. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg, 2008, 12(4): 226-235.
17. Park JH, Lim JW, Kwon YW, et al. Functional outcomes are similar after early and late arthroscopic one-tunnel transosseous repair of triangular fibrocartilage complex foveal tears. Arthroscopy, 2020, 36(7): 1845-1852.
18. 张闻, 刘生和, 柴益民, 等. 腕关节镜下经骨隧道修复三角纤维软骨复合体损伤. 国际骨科学杂志, 2019, 40(6): 357-363.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex injury under wrist arthroscopy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content