Easier Way to Repair Triangular Fibrocartilage Tears in the Wrist

Hand surgeons from the University of Hong Kong report on the use of a new, easier way to repair damage to the triangular fibrocartilage complex (TFCC) of the wrist. A TFCC injury can be a very disabling wrist condition. Current surgical treatments are not always successful in restoring pain free wrist motion and function. This new approach had good results in a small group of 10 patients.

The triangular fibrocartilage complex (TFCC) is an important feature of the wrist. It suspends the ends of the radius and ulna bones of the forearm over the wrist. As the name suggests, it is triangular in shape and made up of several ligaments and cartilage. The TFCC makes it possible for the wrist to move in six different directions (bending, straightening, twisting, side-to-side).

Mild injuries of the TFCC may be referred to as a wrist sprain. As the name suggests, the soft tissues of the wrist are complex. They work together to stabilize the very mobile wrist joint. Disruption of this area through injury or degeneration can cause more than just a wrist sprain.

Triangular fibrocartilage complex (TFCC) injuries of the wrist can affect the ulnar (little finger) side of the wrist or the radial (thumb) side. Radial-sided TFCC tears have a more difficult time healing because of a natural (anatomic) lack of blood supply. And arthroscopic repair of radial-sided TFCC present some interesting challenges for the surgeon.

This new surgical approach was found to be just as useful for radial-sided TFCCs as for ulnar-sided tears, which makes it a very useful treatment tool for hand surgeons. The authors describe the technique step-by-step, including patient position, insertion sites for the arthroscope, type and size of surgical tools used, and of course, details of suture type and location.

For surgeons who are interested, this method uses a curved tip meniscal-double-barrel using an outside-inside technique. The procedure takes less time than other approaches. The technique is simple enough that new surgeons learning how to do it catch on quickly. And the method brings the torn TFCC back to its normal insertion point, which allows for better ligament-to-bone healing. It is believed that improved healing means a good outcome with restoration of function in the end.

A successful result is also one that provides the patient with pain free motion, grip strength, and return to a pre-injury level of employment. For the 10 patients in this study treated with this type of TFCC repair, 50 per cent had a good-to-excellent result. The remaining five patients received a “fair” score using the Mayo Modified Wrist test.

The authors conclude that their new method as described in this article for repair of radial- or ulnar-sided TFCCs is easy and successful. Patients having this procedure can expect to be immobilized in a wrist/forearm brace for three or four weeks. Hand therapy to keep the fingers moving is advised during this period of immobilization. Therapy continues after the brace is discontinued until normal movement and strength are restored (usually about six weeks). Vocational rehab to prepare the patient for return-to-work may take another six-to-eight weeks beyond that.