Department of Orthopedic Surgery, Eulji Medical Center, Seoul, Korea.
Department of Orthopedic Surgery, Korea University, College of Medicine, Guro Hospital, Seoul, Korea.
Arch Orthop Trauma Surg. 2022 Feb;142(2):197-203. doi: 10.1007/s00402-020-03613-1. Epub 2020 Oct 13.
The purpose of this study was to report the clinical outcome of revision arthroscopic triangular fibrocartilage complex (TFCC) foveal repair using a one-tunnel transosseous suture technique after failed primary TFCC repair.
Consecutive patients treated with arthroscopic TFCC foveal repair using the uniform one-tunnel transosseous suture technique after failed TFCC repair from 2014 to 2018 were retrospectively reviewed. The clinical outcome was evaluated using the Modified Mayo Wrist Score (MMWS) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. The Visual Analog Scale (VAS) for pain, stability of the distal radioulnar joint (DRUJ), grip strength, and active range of motion (ROM) of the wrist joint also were assessed.
This study cohort consisted of eight patients, and their mean time to revision after initial surgery was 15.1 months. Previous surgeries were performed using an arthroscopy-assisted mini-open TFCC repair in six cases, an arthroscopic all-inside repair in one case, and an arthroscopic transosseous suture technique in the remaining case. After revisional TFCC foveal repair, all patients demonstrated improved pain and a stable DRUJ. Participants showed improvement in grip strength and mean active wrist ROM. There was improvement in MMWS (from 58.6 to 87.5) and Quick-DASH score (from 46.9 to 12.2) during the mean follow-up of 15.6 months (range: 8-36 months).
Based on the results of this study, remaining ulnar TFCC remnants may be appropriate for sufficient stable repair using an arthroscopic one-tunnel transosseous suture technique after failed primary repair. However, only a small number of patients was examined. A larger number has to be investigated to confirm the promising preliminary results.
Level IV, therapeutic case series.
本研究旨在报告经初次三角纤维软骨复合体（TFCC）修复失败后，采用单隧道经骨隧道缝合技术行关节镜下 TFCC 窝修复的临床结果。
回顾性分析 2014 年至 2018 年采用统一单隧道经骨隧道缝合技术行关节镜下 TFCC 窝修复失败患者，采用改良 Mayo 腕关节评分（MMWS）和快速残疾问卷（Quick-DASH）评分评估临床结果，采用视觉模拟评分（VAS）评估疼痛、下尺桡关节（DRUJ）稳定性、握力和腕关节主动活动范围（ROM）。
本研究队列包括 8 例患者，初次手术后平均 15.1 个月行翻修手术。6 例采用关节镜辅助小切口 TFCC 修复，1 例采用关节镜全内修复，1 例采用关节镜经骨隧道缝合技术，末次随访时所有患者疼痛均减轻，DRUJ 稳定。握力和腕关节主动 ROM 均改善。MMWS（从 58.6 分提高至 87.5 分）和 Quick-DASH 评分（从 46.9 分提高至 12.2 分）均改善。平均随访 15.6 个月（8-36 个月）。
根据本研究结果，初次修复失败后，采用关节镜单隧道经骨隧道缝合技术修复残留的尺侧 TFCC 残端可能获得足够稳定的修复效果，但本研究纳入患者较少，需要进一步研究以确认有前景的初步结果。
IV 级，治疗性病例系列。
