RESUMO
Objective: This study aims to compare the clinical efficacy of two surgical methods, miniaturized anchor nail repair and transosseous tunnel repair, in treating type IB triangular fibrocartilage complex (TFCC) injuries, highlighting the importance of this comparison in optimizing surgical approaches. Methods: We retrospectively analyzed 91 patients with type IB TFCC injuries, treated from June 2020 to January 2022. Group A (43 patients) underwent miniaturized anchor nail repair, and Group B (48 patients) underwent transosseous tunnel repair, both under wrist arthroscopy. Follow-up for 12 months post-surgery included assessments of efficacy, Mayo wrist function score, range of motion, VAS score for ulnar wrist pain, grip strength, DASH score, PRWE, and postoperative complications, along with flow cytometry and lymphocyte immune subset assays. Results: Both groups showed significant improvements in wrist function, grip strength, and range of motion post-surgery, with reduced pain and disability scores. No significant differences in outcomes were observed between the groups. Conclusion: Both miniaturized anchor nail and transosseous tunnel repairs under wrist arthroscopy are effective in improving wrist function and alleviating symptoms in type IB TFCC injuries, with comparable clinical efficacy. These findings could significantly influence surgical practices and future research in TFCC injury management.
RESUMO
BACKGROUND: Recent studies have indicated that depression is associated with persistent postoperative pain and decreased satisfaction following foot and ankle surgery. This study aimed to evaluate the effect of perioperative duloxetine on postoperative outcomes of anterior talofibular ligament (ATFL) surgical repair for chronic ankle instability (CAI) in patients with depression. We further sought to evaluate patients' satisfaction and side effects related to duloxetine. MATERIAL AND METHODS: Patients undergoing ATFL repair were screened for depression preoperatively with the Patient Health Questionnaire (PHQ-9). Among 249 patients who underwent arthroscopic or open surgical Brostrom repair of the ATFL, 120 patients were identified as being "possibly depressed" and were included in the study. Sixty patients were randomly assigned to the duloxetine group (one day preoperatively and for 6 weeks postoperatively), and the other sixty were randomized to the placebo group. Painkillers and opioid consumption, pain scores, and patient satisfaction were recorded at 12, 24, 48, and 72hours postoperatively and at follow-up visits 1, 3, and 6 months after surgery. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 3, 6, 12 and 24 months postoperatively. Duloxetine-related side effects such as nausea/vomiting and fatigue were also recorded. RESULTS: The patients in the duloxetine group reported a significantly longer time to rescue analgesic and reduced opioid requirements (including celecoxib, pregabalin, acetaminophen, and tramadol). The patients experienced decreased pain intensity and greater satisfaction with their pain management at 24, 48, 72h and 1 and 3 months after surgery (p<0.05). The duloxetine group also had significantly better clinical and functional outcomes at 3 and 6 months of follow-up compared to the placebo group (p<0.05). The occurrence and rate of symptoms of duloxetine side effects were not significant. DISCUSSION: Depression is an important factor to consider and address because its presence before surgery can predict poor postoperative outcomes, including more severe postoperative pain, persistent postoperative pain, and increased consumption of painkillers and opioids. CONCLUSION: Perioperative administration of duloxetine following ATFL repair for CAI in patients with depression increased the time to first postoperative rescue analgesic request and reduced both opioid consumption and postoperative pain. This approach also led to a high level of patient satisfaction. In addition, duloxetine improved the quality of recovery without leading to significant side effects. LEVEL OF EVIDENCE: I; prospective randomized controlled trial.