Novel Triple-Loop Technique for Suturing TFCC Injuries without Transosseous Tunnel

Summary

The protocol presented here introduces a new surgical technique for the treatment of triangular fibrocartilage complex injuries.

Abstract

Injuries to the triangular fibrocartilage complex (TFCC) are the most common cause of ulnar-sided wrist pain. As deepening of the research on the function and role of the TFCC, various treatment methods have emerged. Surgical treatment is often required for TFCC injuries that do not respond to conservative therapy. Currently, suturing techniques for TFCC injuries primarily include intra-capsular and transosseous tunnel suture techniques. However, traditional intra-capsular suturing has limited effectiveness for deep tears with a foveal footprint contact, while transosseous tunnel techniques pose problems such as difficulty in locating tunnels and ulna fracture. We have developed an improved triple-loop technique for treating Palmer IB-type TFCC injuries. This technique allows for suturing of both the deep and superficial layers of the TFCC without the need for a transosseous tunnel. Clinical follow-up results show that this is a safe, effective, and simple surgical method for treating TFCC injuries. In this article, we also discussed the comparison between the triple-loop surgical approach and other commonly used surgical approaches.

Introduction

TFCC is a group of important stability structures (such as articular disc, meniscal homolog, the volar and dorsal distal radioulnar ligaments, the deep layer of the ulnar extensor tendon sheath, the ulnar side of the joint capsule, the ulnar lunar ligament, and the ulnar triangular ligament) on the ulnar side of the wrist joint, including the articular disc, meniscal homolog, the volar and dorsal distal radioulnar ligaments, the deep layer of the ulnar extensor tendon sheath, the ulnar side of the joint capsule, the ulnar lunar ligament, and the ulnar triangular ligament. The volar and dorsal distal radioulnar ligaments consist of superficial and deep fibers, which co....

Protocol

This study protocol followed the guidelines of the Human Research Ethics Committee of Shaoxing People's Hospital. Ethics approval number: 2024Z057. Informed consent was obtained from all patients included in this study. All patients agreed to use their data. Figure 1 illustrates the key steps of this surgical technique.

1. Patient selection

1. Include patients with ulnar wrist pain, positive Ballotment test (instability of the distal radioulnar joint; stability rating of 2-3), ineffective and persistent symptoms after at least 2 months of conservative treatment (bracing, oral and t....

Results

We recorded the data of 20 patients who underwent the surgical method described here to treat TFCC injuries. The follow-up time of the patients ranged from 1 month to 7 months. In general, the patients had significant functional improvement after surgery. In terms of VAS score, the VAS score of the patients before surgery was 3.6 ± 0.50, and the VAS score of the patients after surgery was 1.65 ± 0.75, p < 0.0001 (Figure 2). According to another pain assessment scale, the PRWE score signif.......

Discussion

The classic classification of TFCC is based on Plamer et al. proposed in 1989¹¹. According to the location of the injury, TFCC injuries are divided into four types: IA, IB, IC, and ID. Type IA is a traumatic central tear, and type IB is a traumatic ulnar-sided tear, sometimes with concomitant avulsion of the styloid process. Type IC is a traumatic peripheral tear incorporating the ulnolunate and ulnotriquetral ligaments. Type ID is a traumatic radial-sided tear, sometimes with concomitant fracture.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Arthroscopic machine	Smith and Nephew	4K	Arthroscopic imaging system
Automatic Tourniquet System	ULAND	ATSB-III	Reduce surgical bleeding
complex iodine	annjet	annjet-001	Skin disinfection
Planer handle	Smith and Nephew	72201500	Synovial cleaning and wound freshening
Polydioxanone suture	Johnson and Johnson	PDP774D	Sutures
Wrist joint traction system	Smith and Nephew	72202114	Surgical traction