Kim Ji-Sup, Kim Kyeong-Eon, Lee Shin-Woo, Jeon Soyoung, Yang Hyejin, Choi Yun-Rak
Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Arthroscopy. 2025 Jul;41(7):2309-2316. doi: 10.1016/j.arthro.2024.10.040. Epub 2024 Nov 7.
To compare the clinical results of the arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) for distal radioulnar joint (DRUJ) instability in patients with or without generalized joint laxity.
Patients who underwent arthroscopic transosseous foveal TFCC repair of Palmer 1B foveal TFCC tears (Atzei classification class II or III) from January 2018 to October 2021 were identified. Patients treated for symptomatic DRUJ instability for more than 3 months, and with at least 2 years of follow-up, were included. Patients were categorized into two groups based on the Beighton and Horan criteria: those with generalized joint laxity (group L) and those without (group N). Clinical outcomes were measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score (MMWS), wrist range of motion (ROM), grip strength, sports/recreation activity level, recurrent DRUJ instability, and achievement of minimal clinically important differences (MCID).
One-hundred-and-twenty patients (Group L, 51 patients; Group N, 69 patients) were included. Both groups showed significant improvements in preoperative DASH and MMWS at the final follow-up. Overall, 103 patients (85.8%) achieved MCID, with 82.4% in Group L and 88.4% in Group N, and no significant differences between the two groups (P = .347). At the final follow-up, ROM and sports/recreation activity levels were similar between the groups. Significantly, the rates of postoperative DRUJ instability recurrence were 17.7% in group L (9/51) and 5.8% in group N (4/69) (P=0.039). Beighton scores were an independent risk factor for recurrent DRUJ instability in the multivariable analysis (P=0.024; odds ratio=1.62).
Clinical outcomes after arthroscopic TFCC foveal repair in patients with generalized joint laxity are comparable to those without, with 82.4% achieving MCID. Generalized joint laxity impacts DRUJ instability recurrence over a minimum 2-year follow-up period.
Level III, retrospective comparative study.
比较关节镜下三角纤维软骨复合体（TFCC）中央凹修复术治疗有无全身关节松弛的患者桡尺远侧关节（DRUJ）不稳的临床效果。
确定2018年1月至2021年10月期间接受关节镜下经骨TFCC中央凹修复术治疗帕尔默1B型TFCC中央凹撕裂（阿泽分类II级或III级）的患者。纳入因有症状的DRUJ不稳接受治疗超过3个月且至少随访2年的患者。根据贝顿和霍兰标准将患者分为两组：全身关节松弛组（L组）和无全身关节松弛组（N组）。通过手臂、肩部和手部功能障碍（DASH）评分、改良梅奥腕关节评分（MMWS）、腕关节活动范围（ROM）、握力、运动/娱乐活动水平、DRUJ不稳复发情况以及是否达到最小临床重要差异（MCID）来衡量临床结果。
共纳入120例患者（L组51例；N组69例）。两组在末次随访时术前DASH和MMWS均有显著改善。总体而言，103例患者（85.8%）达到MCID，L组为82.4%，N组为88.4%，两组之间无显著差异（P = 0.347）。在末次随访时，两组的ROM和运动/娱乐活动水平相似。值得注意的是，L组术后DRUJ不稳复发率为17.7%（9/51），N组为5.8%（4/69）（P = 0.039）。在多变量分析中，贝顿评分是DRUJ不稳复发的独立危险因素（P = 0.024；比值比 = 1.62）。
全身关节松弛患者关节镜下TFCC中央凹修复术后的临床效果与无全身关节松弛患者相当，82.4%的患者达到MCID。在至少2年的随访期内，全身关节松弛会影响DRUJ不稳的复发。
III级，回顾性比较研究。
