gms | German Medical Science

Objectives/Interrogation: Detachment of deep portion of TFCC from the ulnar fovea induces DRUJ instability. According to biomechanical studies, superficial portion of TFCC, rather than the deeper portion, contributes toward stabilization of DRUJ in pronation; therefore, it would be reasonable to repair not only the deep but also superficial portions. We hypothesized that simultaneous arthroscopic repair of both portions would be effective for Atzei class 2 tear. This prospective study examined the postoperative outcomes and prognostic factors in patients who underwent the procedure.

Methods: We conducted a prospective study which included 33 patients [mean age, 31 years (range, 13-59 years)]; all patients were diagnosed with Atzei class 2 tears by physical examinations, MRI and DRUJ arthroscopy. The mean ulnar variance was +1.1 mm (range, -1 to +4 mm) on radiographs. Arthroscopic TFCC repair was performed using meniscus mender instruments; using 2-0 Fiberwire®, the deep portion was repaired into the fovea through radiocarpal and two dorsal DRUJ portals. Simultaneously, the superficial portion was repaired to the capsule using 3-0 PDS®. Postoperative subjective data were collected every 3 months until a year by Quick DASH score; Mayo wrist score; and grip strength.

We analyzed relationship between prognostic factors and clinical outcomes. We defined the case of poor performance when postoperative cases coincided with the following items. That is, it required additional surgery, Mayo score is 80 points or less, or Quick DASH score is 25 points or more at 1 year after operation.

Results and Conclusions: 3 cases required ulnar shortening osteotomy later. Another 2 cases stayed unsatisfied scores at a year, so 5 cases were categorized the poor. Mean Mayo wrist scores increased from 61 points to 77, 86, 90, and 93, respectively. Mean Quick DASH scores improved from 33 points to 22, 12, 7, and 6. For percentage of grip strength of the contralateral side, the preoperative average improved from 72% to 70, 82, 91, and 98.

As a result of univariate analysis between two groups depending on the results, high ulnar variance and workers compensation insurance users were associated with poor outcome, but the other points were unrelated, such as age, gender, preoperative subjective and objective score and smoking.

Considering the outcomes were excellent, this anatomical reconstructive procedure is recommended for the patients with Atzei class 2 TFCC tear except for workers compensation insurance users and high ulnar variance cases.