[What are the indications for arthroscopic repair of ulnar tears of the TFCC?]

Abstract

A clinical study was performed to assess the outcome after arthroscopic repair of ulnar tears of the TFCC of the wrist, and to determine which factors are of importance for the results. From 1994 until 1998, in 23 patients an ulnar tear of the TFCC of the wrist was found and treated by arthroscopic repair (average age 32 years, range 16 to 56, 11 female, 12 male). The articular disc was sutured by inside-outside-technique with 2/0 PDS to the floor of the sixth extensor compartment. 14 to 54 months (mean 27 months) after the operation, 21 patients were reexamined. The results were graded according to the Mayo-modified wrist score. Several factors which might be of influence were correlated to the results by crosstabs including preoperative clinical assessment of stability of the distal radioulnar joint (DRUJ), time between trauma and repair, mechanism of injury, associated lesions, details of suturing technique, and the amount of loading of the wrist in daily life. In nine patients, the result was rated as excellent, in five patients good, in four patients fair, and in three patients poor. The average preoperative score was 55.7 points, the average postoperative score was 84 points. The difference was statistically significant as calculated by the paired sample t-test (p < 0.05). In preoperative clinical examinations, 13 DRUJs had been assessed as stable, eight as unstable. In the crosstabulation, a significant correlation was found between excellent results and preoperatively preserved stability of the DRUJ, whereas fair and poor results have often been found with clinically unstable DRUJ. The other factors revealed no correlations with the results. Ulnar tears of the TFCC of the wrist without marked instability of the whole DRUJ can be treated by arthroscopic suturing and satisfactory results can be expected. In case of clinical instability of the joint, it is to be assumed that the lesion extends to structures which cannot be seen and sutured arthroscopically. In these cases, open repair after arthroscopic examination must be considered.