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. 2023 Nov;18(8):1258-1266.
doi: 10.1177/15589447221105546. Epub 2022 Jul 9.

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies

Claire Elisabeth Arnolda Koeyvoets  1 , Joris Sebastiaan Teunissen  1 , Reinier Feitz  1   2 , Steven Hovius  1   3 , Elisabeth Hagert  4   5   6 , Egberta Petronella Adriana van der Heijden  1   7
Affiliations

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies

Claire Elisabeth Arnolda Koeyvoets et al. Hand (N Y). 2023 Nov.

Abstract

Background: Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears.

Methods: A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair.

Results: A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair.

Conclusions: These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique.

Keywords: DRUJ instability; TFCC; cadaver studies; systematic review; triangular fibrocartilage complex repair.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of inclusion and exclusion. Note. IOM = interosseous membrane; DOB = distal oblique band.
Figure 2.
Figure 2.
Illustrations of the different techniques for reinsertion of the triangular fibrocartilage complex: (a) illustration of transosseous tunnel repair, (b) illustration of suture anchor repair, (c) illustration of peripheral capsular repair, and (d) illustration of inside-out repair. The articular disk is not depicted to give a better overview of the surgical techniques.
Figure 3.
Figure 3.
Percentage of eliminated translation (PET) for different surgical techniques. A PET above 100% indicates a more stable wrist after reconstruction and below 100% a less stable wrist after reconstruction. The corresponding study is displayed above each bar.
Figure 4.
Figure 4.
Maximum amount of load before a gap of 2 mm formed across the repair site for the 3 different surgical techniques.
Figure 5.
Figure 5.
Mechanism of failure of different surgical techniques of triangular fibrocartilage complex reinsertion.
See this image and copyright information in PMC

References

    1. Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol. 2009;34(5):582-591. - PubMed
    1. Yao J. All-arthroscopic repair of peripheral triangular fibrocartilage complex tears using FasT-Fix. Hand Clin. 2011;27(3):237-242. - PubMed
    1. Chen AC, Weng CJ, Chiu CH, et al.. Results of arthroscopic repair of peripheral triangular fibrocartilage complex tear with exploration of dorsal sensory branch of ulnar nerve. Open Orthop J. 2017;11:525-532. - PMC - PubMed
    1. Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am. 2000;25(3):464-468. - PubMed
    1. Haugstvedt JR, Søreide E. Arthroscopic management of triangular fibrocartilage complex peripheral injury. Hand Clin. 2017;33(4):607-618. - PubMed

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