Waitayawinyu Thanapong, Sekekun Narut, Sopasilapa Petai, Boonyasirikool Chinnakart
Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99/209 Paholyothin Rd, Klong Luang, Pathumthani, 12120, Thailand.
Arch Orthop Trauma Surg. 2023 Mar;143(3):1707-1714. doi: 10.1007/s00402-022-04600-4. Epub 2022 Sep 10.
Key step of arthroscopic triangular fibrocartilage complex (TFCC) foveal reattachment is to suture dorsal and palmar deep components of radioulnar ligaments (RULs) to the fovea of ulnar head to ensure distal radioulnar joint stability. However, the deep components are covered and cannot be identified arthroscopically from standard radiocarpal joint view. Suturing sites described in previous studies have not been proved gasping of the deep components. The purpose of this study was to investigate our TFCC suture locations using relevant landmarks on securing the RULs' deep components for arthroscopic TFCC foveal reattachment.
Wrist arthroscopy and horizontal mattress suture was performed in 20 fresh-frozen cadaver wrists. Based on close proximity of the ulnocarpal ligaments to the palmar RUL and fovea, palmar suture location was designated at the junction between ulnolunate, ulnotriquetral ligaments and palmar border of TFCC disc, whereas dorsal suture location was at dorsal border of TFCC disc, opposite the palmar location, at same distance between prestyloid recess and palmar location. The radiocarpal and ulnocarpal joint was subsequently opened to evaluate grasping of RULs' deep components and evaluate the relevant landmarks.
Thirty-nine of 40 (97%) RULs' deep components were successfully grasped by the sutures. With 0.98-0.99 interobserver agreement for the measurements, mean distance between sigmoid notch to suture and suture to ulnar capsule were 5.6 ± 1.1 and 4.0 ± 0.9 mm, respectively. Whereas, the dissecting point of deep component from the superficial component of the RULs was detected immediately radial to the midpoint between the sigmoid notch and the ulnar capsule (4.5 ± 0.9 mm from sigmoid notch).
We determined the relevant anatomical landmarks to navigate the TFCC suture locations, which reliably secure the deep components of the radioulnar ligaments for the arthroscopic TFCC foveal reattachment.
关节镜下三角纤维软骨复合体（TFCC）中央凹重新附着的关键步骤是将桡尺韧带（RULs）的背侧和掌侧深层部分缝合至尺骨头中央凹，以确保桡尺远侧关节的稳定性。然而，深层部分被覆盖，从标准的桡腕关节视野无法通过关节镜识别。先前研究中描述的缝合部位尚未被证实能抓住深层部分。本研究的目的是利用相关标志来研究我们在关节镜下TFCC中央凹重新附着时固定RULs深层部分的TFCC缝合位置。
对20个新鲜冷冻尸体手腕进行腕关节镜检查和水平褥式缝合。基于尺腕韧带与掌侧RUL和中央凹的紧密相邻关系，掌侧缝合位置定于尺月韧带、尺三角韧带与TFCC盘掌侧边缘的交界处，而背侧缝合位置在TFCC盘的背侧边缘，与掌侧位置相对，在茎突前隐窝与掌侧位置之间的相同距离处。随后打开桡腕关节和尺腕关节，评估RULs深层部分的抓持情况并评估相关标志。
40条RULs中的39条（97%）深层部分被缝线成功抓住。测量的观察者间一致性为0.98 - 0.99，乙状切迹至缝线和缝线至尺侧关节囊的平均距离分别为5.6±1.1和4.0±0.9毫米。而RULs深层部分从浅层部分的解剖分离点在乙状切迹与尺侧关节囊中点的径向外侧立即被检测到（距乙状切迹4.5±0.9毫米）。
我们确定了相关的解剖标志以引导TFCC缝合位置，这能可靠地固定桡尺韧带的深层部分用于关节镜下TFCC中央凹重新附着。
