Arthroscopically assisted repair of foveal triangular fibrocartilage complex tear using modified "double loop suture" - a retrospective cohort study.

Abstract

Background: The triangular fibrocartilage complex (TFCC) plays an important role in distal radioulnar joint (DRUJ) stabilization, and is frequently torn. In particular, when conservative treatment fails, surgical treatment is needed.

Methods: In this retrospective study, fourteen individuals with TFCC foveal tears and DRUJ instability were admitted to the department and treated with arthroscopic-assisted modified "double loop suture" transosseous repair between January 2021 and 2023. During surgery, an osseous tunnel was established, and two nickel-based alloy loops and a 2-0 polydioxanone II (PDS II) suture were used to achieve anatomic repair of the tear. All patients received supervised rehabilitation exercises after surgery.

Results: The patients were followed for an average of 15 months. The mean visual analog scale (VAS) score, which was used to assess the pain intensity experienced by patients using their affected hand, significantly decreased from 5 (95% CI 4-6) points preoperatively to 2 (95% CI 1-3) points at the final follow-up (p < 0.05). The grip strength and Disabilities of the Arm, Shoulder, and Hand (DASH) score before surgery were 17 (95% CI 13-22) kg and 35 (95% CI 26-44) points, respectively, compared with 21 (95% CI 16-25) kg and 16 (95% CI 9-22) points at the final follow-up (p < 0.05). The median Patient-Rated Wrist Evaluation (PRWE) score was 28 (IQR 21, 48) before surgery, which then significantly decreased to 10 (IQR 6, 15) at the final follow-up. The mean flexion‒extension range of the wrist significantly increased from 111 (95% CI 100-122) degrees before surgery to 116 (95% CI 106-126) degrees postsurgery (p < 0.05), and the mean pronation‒supination range of the forearm significantly improved from 125 (95% CI 110-140) degrees to 135 (95% CI 121-149) degrees at the final follow-up assessment (p < 0.05). None of the assessed individuals exhibited DRUJ instability, as evaluated by the ballottement test or developed surgery-related complications such as postoperative infection, injury to the dorsal branch of the ulnar nerve or iatrogenic ulnar styloid fracture caused by the establishment of an osseous tunnel.

Conclusion: Arthroscopic-assisted modified "double loop suture" is a secure and efficient approach for achieving anatomic repair of TFCC foveal tears, with satisfactory functional improvement and DRUJ stability restoration.