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Clinical Outcomes of Arthroscopic One-Tunnel Triangular Fibrocartilage Complex Transosseous Suture Repair Are Not Diminished in Cases of Ulnar Styloid Process Fracture Nonunion

      Purpose

      To determine whether clinical outcomes of arthroscopic one-tunnel wrist triangular fibrocartilage complex (TFCC) transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion (USPFN).

      Methods

      Patients who underwent arthroscopic 1-tunnel transosseous suture repair of Palmer 1B foveal TFCC tear (with/without superficial fiber tear; Atzei class 2 or 3 TFCC tear) from 2015 to 2020 were retrospectively reviewed. Group I was the TFCC foveal tear repair group with USPFN. Group II was the TFCC foveal tear repair group without USPFN. In group I, no additional treatment for USPFN was made. Functional preoperative and postoperative outcomes were compared by Modified Mayo Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; grip strength; pain visual analog scale (VAS); and distal radioulnar joint (DRUJ) stability. Wrist posteroanterior, lateral, and both oblique views of the wrist were used to assess the ulnar styloid process before and after operation.

      Results

      This study consisted of 66 patients: group I (n = 22) and group II (n = 44). No differences were found between the 2 groups preoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .94, Quick-DASH: P = .23, grip strength: P = .69, VAS: P = .45). No differences were found between the 2 groups with respect to outcome measures postoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .59, Quick DASH: P = .82, grip strength: P = .15, VAS: P = .84). All of the enrolled patients achieved restored function with negative ballottement test and maintained DRUJ stability on follow-up. Of the 22 USPFN cases in group I, 11 (50%) showed spontaneous union after transosseous TFCC foveal repair without any additional USPFN treatment. The proportion of patients achieving a minimal clinically important difference for the Quick-DASH was similar between the 2 groups.

      Conclusions

      Although this current study has insufficient statistical power, the available data suggest that patients with TFCC foveal tear combined with USPFNs treated with arthroscopic transosseous repair surgery could experience similar functional improvement compared with those with TFCC foveal tear without USPFNs. The presence of USPFN accompanied by Palmer 1B type TFCC foveal tear may not affect the clinical results, including MMWS, Quick-DASH, grip strength, VAS, and DRUJ stability of patients who undergo arthroscopic 1-tunnel transosseous suture repair.

      Level of Evidence

      Level III, retrospective comparative study.
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      References

        • Mak M.C.-K.
        • Ho P-c
        Arthroscopic-assisted triangular fibrocartilage complex reconstruction.
        Hand Clin. 2017; 33: 625-637
        • Estrella E.P.
        • Hung L.-K.
        • Ho P.-C.
        • Tse W.L.
        Arthroscopic repair of triangular fibrocartilage complex tears.
        Arthroscopy. 2007; 23 (e721): 729-737
        • de Araujo W.
        • Poehling G.G.
        • Kuzma G.R.
        New Tuohy needle technique for triangular fibrocartilage complex repair: Preliminary studies.
        Arthroscopy. 1996; 12: 699-703
        • Yao J.
        All-arthroscopic triangular fibrocartilage complex repair: Safety and biomechanical comparison with a traditional outside-in technique in cadavers.
        J Hand Surg Am. 2009; 34: 671-676
        • Pederzini L.A.
        • Tosi M.
        • Prandini M.
        • Botticella C.
        All-inside suture technique for Palmer class 1B triangular fibrocartilage repair.
        Arthroscopy. 2007; 23 (1130.e1131-1130.e1134)
        • Conca M.
        • Conca R.
        • Dalla Pria A.
        Preliminary experience of fully arthroscopic repair of triangular fibrocartilage complex lesions.
        Arthroscopy. 2004; 20: e79-e82
        • Böhringer G.
        • Schädel-Höpfner M.
        • Petermann J.
        • Gotzen L.
        A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears.
        Arthroscopy. 2002; 18: 211-213
        • Moritomo H.
        • Masatomi T.
        • Murase T.
        • Miyake J-i
        • Okada K.
        • Yoshikawa H.
        Open repair of foveal avulsion of the triangular fibrocartilage complex and comparison by types of injury mechanism.
        J Hand Surg Am. 2010; 35: 1955-1963
        • Nakamura T.
        • Sato K.
        • Okazaki M.
        • Toyama Y.
        • Ikegami H.
        Repair of foveal detachment of the triangular fibrocartilage complex: Open and arthroscopic transosseous techniques.
        Hand Clin. 2011; 27: 281-290
        • Park J.W.
        Surgical techniques for repairing foveal tear of the triangular fibrocartilage complex: Arthroscopic transosseous repair.
        Arch Hand Microsurg. 2014; 19: 95-102
        • Park J.H.
        • Park J.W.
        Arthroscopic transosseous repair for both proximal and distal components of peripheral triangular fibrocartilage complex tear.
        Indian J Orthop. 2018; 52: 596-601
        • Burgess R.C.
        • Watson H.K.
        Hypertrophic ulnar styloid nonunions.
        Clin Orthop Relat Res. 1988; : 215-217
        • Nunez Jr., F.
        • Luo T.
        • Nunez Sr F.
        Treatment of symptomatic non-unions of the base of the ulnar styloid with plate osteosynthesis.
        J Hand Surg Eur. 2017; 42: 382-388
        • Protopsaltis T.S.
        • Ruch D.S.
        Triangular fibrocartilage complex tears associated with symptomatic ulnar styloid nonunions.
        J Hand Surg Am. 2010; 35: 1251-1255
        • Bacorn R.W.
        • Kurtzke J.F.
        COLLES'FRACTURE: A study of two thousand cases from the New York State Workmen's Compensation Board.
        J Bone Joint Surg Am. 1953; 35: 643-658
        • May M.M.
        • Lawton J.N.
        • Blazar P.E.
        Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability.
        J Hand Surg Am. 2002; 27: 965-971
        • Atzei A.
        • Rizzo A.
        • Luchetti R.
        • Fairplay T.
        Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability.
        Tech Hand Up Extrem Surg. 2008; 12: 226-235
        • Nakamura R.
        • Horii E.
        • Imaeda T.
        • Nakao E.
        • Kato H.
        • Watanabe K.
        The ulnocarpal stress test in the diagnosis of ulnar-sided wrist pain.
        J Hand Surg Eur. 1997; 22: 719-723
        • Atzei A.
        • Luchetti R.
        Foveal TFCC tear classification and treatment.
        Hand Clin. 2011; 27: 263
        • Moriya T.
        • Aoki M.
        • Iba K.
        • Ozasa Y.
        • Wada T.
        • Yamashita T.
        Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: A biomechanical study.
        J Hand Surg Eur. 2009; 34: 219-223
        • Trehan S.K.
        • Wall L.B.
        • Calfee R.P.
        • et al.
        Arthroscopic diagnosis of the triangular fibrocartilage complex foveal tear: A cadaver assessment.
        J Hand Surg Am. 2018; 43 (680.e681-680.e685)
        • Park J.H.
        • Kim D.
        • Park J.W.
        Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear.
        Arch Orthop Trauma Surg. 2018; 138: 131-138
        • Park J.H.
        • Lim J.W.
        • Kwon Y.W.
        • Kang J.W.
        • Choi I.C.
        • Park J.W.
        Functional outcomes are similar after early and late arthroscopic one-tunnel transosseous repair of triangular fibrocartilage complex foveal tears.
        Arthroscopy. 2020; 36: 1845-1852
        • Franchignoni F.
        • Vercelli S.
        • Giordano A.
        • Sartorio F.
        • Bravini E.
        • Ferriero G.
        Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39
        • Polson K.
        • Reid D.
        • McNair P.J.
        • Larmer P.
        Responsiveness, minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire.
        Man Ther. 2010; 15: 404-407
        • Sorensen A.A.
        • Howard D.
        • Tan W.H.
        • Ketchersid J.
        • Calfee R.P.
        Minimal clinically important differences of 3 patient-rated outcomes instruments.
        J Hand Surg Am. 2013; 38: 641-649
        • Buijze G.A.
        • Ring D.
        Clinical impact of united versus nonunited fractures of the proximal half of the ulnar styloid following volar plate fixation of the distal radius.
        J Hand Surg Am. 2010; 35: 223-227
        • Zenke Y.
        • Sakai A.
        • Oshige T.
        • Moritani S.
        • Nakamura T.
        The effect of an associated ulnar styloid fracture on the outcome after fixation of a fracture of the distal radius.
        J Bone Joint Surg Br. 2009; 91: 102-107
        • Nakamura T.
        • Yabe Y.
        • Horiuchi Y.
        Functional anatomy of the triangular fibrocartilage complex.
        J Hand Surg Am. 1996; 21: 581-586
        • Shin W.-J.
        • Kim J.-P.
        • Yang H.-M.
        • Lee E.-Y.
        • Go J.-H.
        • Heo K.
        Topographical anatomy of the distal ulna attachment of the radioulnar ligament.
        J Hand Surg Am. 2017; 42: 517-524
        • Kleinman W.B.
        Stability of the distal radioulna joint: Biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years.
        J Hand Surg Am. 2007; 32: 1086-1106
        • Haugstvedt J.
        • Langer M.
        • Berger R.
        Distal radioulnar joint: Functional anatomy, including pathomechanics.
        J Hand Surg Eur. 2017; 42: 338-345
        • Haugstvedt J.-R.
        • Berger R.A.
        • Nakamura T.
        • Neale P.
        • Berglund L.
        • An K.-N.
        Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint.
        J Hand Surg Am. 2006; 31: 445-451
        • Iwasaki N.
        • Nishida K.
        • Motomiya M.
        • Funakoshi T.
        • Minami A.
        Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: A 2-to 4-year follow-up study.
        Arthroscopy. 2011; 27: 1371-1378
        • Abe Y.
        • Fujii K.
        • Fujisawa T.
        Midterm results after open versus arthroscopic transosseous repair for foveal tears of the triangular fibrocartilage complex.
        J Wrist Surg. 2018; 7: 292-297