[Arthroscopically assisted transcapsular refixation of the triangular fibrocartilage complex of the wrist].

OBJECTIVE

Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist.

INDICATIONS

Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability.

CONTRAINDICATIONS

Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential.

SURGICAL TECHNIQUE

Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment.

POSTOPERATIVE MANAGEMENT

Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months.

RESULTS

In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68-152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0-10), pain at rest was 1 ± 1 (range 0-2) and pain during exercise 2 ± 2 (range 0-5); the DASH score averaged 10 ± 14 points (range 0-39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series.

CONCLUSION

Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.