Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

Conflict of interest statement: CONFLICT OF INTEREST: Eric Quan Pang declares that he has no conflict of interest. Jeffrey Yao reports personal fees from Smith and Nephew Endoscopy during the conduct of study. He also reports personal fees from Arthrex, BME, McGinley Orthopedics, and Trimed, as well as a grant from Medartis, outside of the submitted work. HUMAN AND ANIMAL RIGHTS AND INFORMED CONSENT: This article does not contain any studies with human or animal subjects performed by any of the authors. 13. J Wrist Surg. 2021 Oct 5;12(1):2-8. doi: 10.1055/s-0041-1735981. eCollection 2023 Feb. Allinside Anatomic Arthroscopic (3A) Reconstruction of Irreparable TFCC Tear. Atzei A(1), Tandioy-Delgado FA(2), Marcovici LL(3), Aust TW(4), Luchetti R(5). Author information: (1)Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy. (2)Hand Surgery, Clinica las Américas, Medellin, Antioquia, Colombia. (3)Hand & Microsurgery Unit, Jewish Hospital of Rome, Rome, Italy. (4)Arthrex GmbH, München, Germany. (5)Rimini Hand and Upper Limb Surgery & Rehabilitation Center, Rimini, Italy. Background  In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams-Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. Description of Technique  The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small incision in the radial metaphyseal area and arthroscopic control are required to set a Wrist Drill Guide and create two converging tunnels, whose openings are at the radial anatomical origins of the RUL. An ulnar tunnel is drilled at the fovea from inside-out via the 6U portal. A 3-mm tendon strip, from the palmaris longus or extensor carpi radialis brevis, is woven through the tunnels and then secured into the ulnar tunnel with an interference screw. Postoperative immobilization with restricted forearm rotation is discontinued at 5 weeks, and then postoperative rehabilitation is started. Patients and Methods  The 3A technique was applied on 5 patients (2 females and 3 males), with an average age 42 years. DRUJ stability, range of motion (ROM), pain (0-10 visual analogue scale [VAS]), grip strength, modified Mayo wrist score (MMWS), and patient satisfaction were used for evaluation before surgery and at follow-up. Results  No intraoperative or early complications were registered. At a mean follow-up of 26 months, DRUJ was stable in all patients, which recovered 99% ROM. Pain VAS decreased from 7 to 0.6. Grip strength increased from 38 to 48.8 Kgs. There were 4 excellent results and 1 good result on MMWS. All patient showed high satisfaction. Conclusions  Although the 3A technique requires dedicated instrumentation and arthroscopic expertise, it takes advantage of improved intra-articular vision and minimized surgical trauma to reduce the risk of complications and obtain promising functional results. Thieme. All rights reserved. DOI: 10.1055/s-0041-1735981 PMCID: PMC9836779