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A Simplified Arthroscopic Capsular Repair for Peripheral Triangular Fibrocartilage Complex Tears
Takehiko Takagi, MD, PhD1; Toshiyasu Nakamura, MD, PhD2; Kazuki Sato, MD, PhD1; Yoshiaki Toyama, MD, PhD1
1School of Medicine, Keio University, Tokyo, Japan; 2Keio University, Tokyo, Japan

Introduction: The objective of this study was to describe the incidence of differing types of peripheral detachments and the clinical outcomes following the triangular fibrocartilage complex (TFCC) lesion repair with the arthroscopic outside-in technique.
Materials and Methods: Twenty-four wrists from 24 cases who underwent arthroscopic capsular repair were included in this study. Nine patients (38%) had a significant history of sports injury and 15 had a history of trauma. The time from injury to surgery averaged 15.4 months (range, five days to 60 months). Details of the ulnar tear were recorded and clinical results were analyzed.
Results: Simple ulnar avulsion (Palmer 1B) was recognized in ten wrists. A combination of the 1B tear with a horizontal triangular fibrocartilage (TFC) tear was noted in six wrists; and ulnar avulsion extending to the dorsal half of the TFC was identified in eight wrists, including complete dorsal avulsion of the TFC from the capsule. The results of the shorter preoperative duration group (15 months or less) were excellent in 14 cases and good in two. The results for the longer preoperative duration group (more than 15 months) were excellent in four cases, good in one, and fair in three. There are significantly better results in the cases whose preoperative periods were 15 months or less. (p = 0.030).
Conclusion: Our outside-in technique provides wide open space outside of the radiocarpal joint for relaying the main stitches without special devices. These loop stitches could easily and securely introduce the main suture to the TFCC. Capsular TFCC repair produced excellent clinical results for peripheral detachment of the TFC at the ulnar and dorsal sites in the cases whose preoperative periods were less than 15 months.


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