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Arthroscopic Evaluation of Regeneration of the TFCC after Ulnar Shortening Procedure
Toshiyasu Nakamura, MD, PhD; Koji Abe, MD
Clinical Research Center, International University of Health and Welfare, Tokyo, Japan
Ulnar shortening procedure is widely indicated to degenerative tear of the triangular fibrocartilage complex (TFCC) with the positive ulnar variance. Tatebe et al. described that degeneration of the TFCC could be recovered after ulnar shortening. We evaluated recovery of the degenerative TFCC through first and second look arthroscopy.
Methods: 663 wrists had undergone ulnar shortening by single surgeon in our institute. Among them, 282 wrists of 276 patients who indicated Palmer 2A to 2D degeneration on the TFCC were included in this retrospective analysis. There were 128 males, 148 females with an average age of 42 (24-78). Right wrists were 140, left 136 and 6 bilateral. Pre-operative ulnar variance indicated 2.48 (0-11.5) mm. All patients claimed pain and 25 wrists indicated loss of forearm rotation. Eighty one wrists indicated mild DRUJ instability comparing to the intact side and moderate DRUJ instability in 37. There was no severe DRUJ instability case and 164 wrists indicated no DRUJ instability. All wrists underwent wrist arthroscopy including DRUJ arthroscopy at the time of ulnar shortening (first look), then the ulnar was shortened by an average 2.6 (2-11) mm. At the time of plate removal, all wrists underwent second look arthroscopy. We evaluated the first and second look arthroscopic findings and clinical outcome using DRUJ evaluation system (Nakamura et al., 2011).
Results: The first look showed Palmer 2A in 173 wrists, 2B in 33, 2C in 68 and 2D in 8 via radiocarpal arthroscopy. DRUJ arthroscopy indicated partial dorsal RUL avulsion in 9 wrists and degeneration of the proximal surface of the TFCC in 266. The second look demonstrated recovery of the Palmer’s classification in 115 wrists (41%) and perforation at the triangular fibrocartilage (TFC) was fully covered by synovium in 55 wrists (73%) among 76 perforations. Recovery of proximal surface of the TFC was noted in 250 wrists among 266 (94%) through DRUJ arthroscopy. Final clinical outcomes obtained was excellent in 261, good in 20 and fair in 1 and no poor clinical results.
Conclusion: Ulnar shortening indicated recovery of the degeneration of the TFCC more in the proximal surface than the distal side of the TFCC. Perforation of the TFC was recovered in 73%.
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