Article
Arthroscopic Anatomic Allinside (3A) reconstruction of the TFCC
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Published: | February 6, 2020 |
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Objectives/Interrogation: To report the preliminary experience on a novel technique of arthroscopically assisted tendon graft reconstruction of the Triangular Fibrocartilage Complex (TFCC) in the treatment of Distal Radio-Ulnar Joint (DRUJ) instability resulting from irreparable tears.
Methods: The technique uses a 3mm strip of the ECRL tendon, which is introduced in a radial metaphyseal tunnel originating from the anatomical sites of insertion of the DRUJ ligaments at the edges of the sigmoid notch.
The tunnel is created under arthroscopic control using a wrist drill guide. The ulnar tunnel accepting the extremities of the tendon graft is created with an in-out technique, under arthroscopic control, to allow for the intra-articular fixation of the graft, using an interference screw.
Postoperative immobilization with restricted forearm rotation was discontinued at 5 weeks, then post-operative rehabilitation was started.
This novel technique was used in 5 patients, that were reviewed at minimum follow-up of 18 months. The DRUJ stability, visual analog scale of pain (VAS), ability to return to work, Prono-Supination range, grip strength and the Mayo Wrist Score were used for evaluation.
Results and Conclusions: We had no intra-operative complications. All patients had a stable DRUJ at follow-up and returned to previous work. VAS was significantly reduced and Prono-Supination, grip strength, and Mayo Wrist Score increased post-operatively.
Compared to the previously described techniques of tendon graft reconstruction of the TFCC, this novel technique shows the main advantage to replicate the anatomic location of the tendon graft on the radius, which is achieved totally under arthroscopic control, without the need of fluoroscopy, with limited periarticular surgical dissection.