ABSTRACT
Objective:
To investigate the
clinical efficacy of
wrist arthroscopic transosseous footprint repair
technique for treating
triangular fibrocartilage complex (TFCC)
injury.
Methods:
A retrospective case series study was conducted to analyze the clinical data of 56
patients with TFCC
injury admitted to Shenzhen Second People′s
Hospital from July 2017 to September 2020, including 38
males and 18
females,
aged 17-45 years [(33.5±3.6)years]. All
patients had unilateral
injury.
Physical examination showed instability of the distal radioulnar
joint, and MRI and
arthroscopy confirmed deep
ligament injury of TFCC. All
patients underwent repair of deep insertion of the TFCC by using
wrist arthroscopic transosseous footprint. The operation
time, intraoperative
blood loss,
wound healing and
postoperative complications were recorded. The flexion and extension
range of motion of the
wrist, radial and ulnal deviation of the
wrist,
rotation range of motion of the
forearm,
patient related
wrist evaluation (PRWE) score, modified Mayo
wrist score, visual analogue scale (VAS), and percentage of
grip strength between the affected side and unaffected side were compared preoperatively, at 3 months postoperatively and at 1 year postoperatively.
Results:
All
patients were followed up for 12-18 months [(13.4±5.2)months]. The operation
time was (61.3±8.9)minutes, with the intraoperative
blood loss of (2.4±1.2)ml. All
wounds were healed by first intension. There was no
wound infection or
ulnar nerve irritation symptom after operation. Four
patients experienced clicking on the ulnar side of the
wrist in a short period of
time post-operation, with spontaneous disappearance of the symptom. At 3 months postoperatively, the radial and ulnar deviation of the
wrist was decreased from (52.5±5.9)° preoperatively to (42.6±5.9)°, and
rotation range of motion of the
forearm was decreased from (94.9±8.4)°preoperatively to (84.6±5.9)° (all P<0.01). The flexion and extension
range of motion of the
wrist was (93.1±17.4)° preoperatively, with insignificant difference compared with (89.4±5.8)° at 3 months postoperatively ( P>0.05). At 1 year postoperatively, the flexion and extension
range of motion of the
wrist, radial and ulnar deviation
range of motion of the
wrist, and
rotation range of motion of the
forearm were significantly increased to (101.3±13.6)°, (52.4±6.6)°, and (116.4±16.4)° when compared with those at 3 months postoperatively (all P<0.01). At 3 months postoperatively, the PRWE score was increased to (17.1±3.8)points from (10.6±3.2)points preoperatively ( P<0.01), modified Mayo
wrist score was decreased to (70.3±6.7) points from (78.1±12.7)points preoperatively ( P<0.01), VAS was decreased to (4.4±1.7)points from (6.2±1.5)points preoperatively ( P>0.05), and percentage of
grip strength between the affected side and unaffected side was decreased to (55.7±8.7)% from (74.4±15.2)% preoperatively ( P<0.01). At 1 year postoperatively, the PRWE score was increased to (2.0±0.9)points, modified Mayo
wrist score was increased to (94.8±3.3)points, VAS was decreased to (2.1±1.1)points, and percentage of
grip strength between the affected side and unaffected side was increased to (93.2±8.7)% when compared with those at 3 months postoperatively (all P<0.01).
Conclusion:
Wrist arthroscopic transosseous footprint repair
technique can effectively treat deep
ligament injury of TFCC, with advantages of significantly improving postoperative
joint range of motion and functional score, relieving the
pain on the ulnar side of the
wrist and enhancing
grip strength.