Vilai Parunyu, Thoreson Andrew R, Yin Cheng-Yu, Hooke Alexander W, Trentadue Taylor P, Zhao Kristin D, Kakar Sanjeev
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Faculty of Medicine, Srinakharinwirot University, Bangkok, Thailand.
Assistive and Restorative Technology Laboratory, Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN.
J Hand Surg Am. 2025 Sep 12. doi: 10.1016/j.jhsa.2025.07.015.
The triangular fibrocartilage complex (TFCC) is the primary stabilizer of the distal radioulnar joint (DRUJ). Injury to the TFCC's foveal insertion can cause ulnar-sided wrist pain and DRUJ instability. The aim of this study was to assess DRUJ stability, as measured by volar-dorsal translation, after TFCC foveal repair using an arthroscopic "over-the-top" technique.
After obtaining institutional biospecimens approval, eight fresh-frozen cadavers were procured. Distal radioulnar joint instability was defined as an increase in sagittal translation of the distal ulna relative to the radius. A custom biomechanical testing protocol was implemented, which involved applying a linear translation to the radius and measuring both the applied force and bone displacement in the dorsal-volar direction. The stability of the DRUJ was tested with an intact foveal insertion and ulnar styloid insertion, after release of the entire TFCC foveal insertion and transection of the superficial TFCC attachment to the ulnar styloid, and then after the "over-the-top" technique repair with three different suture configurations. Distal radioulnar joint stability was assessed in the following three wrist positions: neutral, 60° pronation, and 60° supination using both translation and stability improvement as outcomes.
Distal radioulnar joint translation increased between the intact and injured conditions in neutral, pronation, and supination. Suture repair improved DRUJ translation compared with the injured state. Percent stability improvement, calculated relative to the injured condition, was higher across all repair groups. A single suture repair restored approximately half the stability relative to the injured condition, whereas the three-suture repair demonstrated the greatest improvement in DRUJ stability.
"Over-the-top" TFCC foveal repairs can enhance postoperative DRUJ stability.
"Over-the-top" TFCC foveal repair using three sutures provides the greatest improvement in DRUJ stability in a cadaveric model. These findings may help guide surgical decision-making regarding the optimal number of sutures needed to restore DRUJ stability following foveal TFCC injuries.
三角纤维软骨复合体（TFCC）是桡尺远侧关节（DRUJ）的主要稳定结构。TFCC中央凹附着处损伤可导致尺侧腕部疼痛和DRUJ不稳定。本研究的目的是评估采用关节镜“过顶”技术修复TFCC中央凹后，通过掌背侧平移测量的DRUJ稳定性。
获得机构生物标本批准后，获取了8具新鲜冷冻尸体。桡尺远侧关节不稳定定义为尺骨远端相对于桡骨矢状面平移增加。实施了定制的生物力学测试方案，该方案包括对桡骨施加线性平移，并测量施加的力和背掌方向的骨位移。在完整的中央凹附着和尺骨茎突附着状态下、在完全松解TFCC中央凹附着并切断TFCC浅部附着于尺骨茎突后、以及在采用三种不同缝合构型进行“过顶”技术修复后，测试DRUJ的稳定性。在以下三个腕部位置评估桡尺远侧关节稳定性：中立位、旋前60°和旋后60°，以平移和稳定性改善作为结果。
在中立位、旋前位和旋后位，完整状态与损伤状态之间桡尺远侧关节的平移增加。与损伤状态相比，缝合修复改善了DRUJ的平移。相对于损伤状态计算的稳定性改善百分比在所有修复组中都更高。单缝修复相对于损伤状态恢复了约一半的稳定性，而三缝修复在DRUJ稳定性方面表现出最大改善。
“过顶”TFCC中央凹修复可增强术后DRUJ稳定性。
在尸体模型中，采用三缝进行“过顶”TFCC中央凹修复在DRUJ稳定性方面改善最大。这些发现可能有助于指导关于修复TFCC中央凹损伤后恢复DRUJ稳定性所需最佳缝合数量的手术决策。
