Purpose
To quantify the distance of the dorsal ulnar sensory branch, floor of the extensor
carpi ulnaris (ECU) subsheath, and ulnar neurovascular bundles from the triangular
fibrocartilage complex (TFCC), and secondarily to assess the safety of an all-inside
arthroscopic repair of the TFCC with a commonly used meniscal repair device with respect
to the aforementioned structures.
Methods
A custom K-wire with 1-mm gradation was used to determine the distance of at-risk
structures from the periphery of the TFCC in 13 above-elbow human cadaver specimens.
An all-inside repair of the TFCC at the location of a Palmer 1B tear was then performed
using a commonly employed meniscal repair device. The distance from the deployed devices
to the structure in closest proximity was then measured using digital calipers.
Results
The mean distance from the deployed device to the nearest structure of concern for
iatrogenic injury was 9.4 mm (range, 5-15 mm). The closest structure to iatrogenic
injury was usually, but not always, the dorsal ulnar sensory nerve in 9 of 13 wrists
(69.2%) at 9.3 mm (range, 5-15 mm); on 3 occasions it was instead the ulnar nerve
(23.1%) at 9.5 mm (range, 9-10 mm), and on 1 occasion 6 mm from the flexor digitorum
profundus to the little finger (7.7%). Forearm rotation had no significant effect
on measured distances (ulnar nerve: P = .98; dorsal sensory: P = .89; ECU: P = .90). The largest influence of forearm rotation was a 0.4-mm difference between
pronation and supination with respect to the distance of the TFCC periphery on the
ECU subsheath.
Conclusions
An all-inside arthroscopic TFCC repair using a commonly used meniscal repair device
appears safe with respect to nearby neurovascular structures and tendons under typical
arthroscopic conditions.
Clinical Relevance
An all-inside arthroscopic TFCC repair using a commonly employed meniscal repair device
appears safe in terms of proximity to important structures although further clinical
investigation is warranted.
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Article Info
Publication History
Published online: September 07, 2016
Accepted:
June 23,
2016
Received:
December 11,
2015
Footnotes
The authors report the following potential conflicts of interests or sources of funding: R.D.P. is on the editorial board of Wolters Kluwer Health, Lippincott Williams & Wilkins, and Journal of Orthopaedic Trauma. R.G.G. receives support from BME, Biomet, Auxillium, and Smith & Nephew; is a board member of American Society for Surgery of the Hand; and is on the editorial board of Journal of Hand Surgery—American.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
