Dorsoulnar injury of the TFCC: clinical features, diagnosis, and treatment

Abstract

Abstract Introduction TFCC lesions are commonly categorized according to the classification system proposed by Andrew K. Palmer in 1989, which received a lot of attention in recent years due to the development of wrist arthroscopy. However, various investigations highlighted other types of lesions that are not listed in this system. This article aims to describe the clinical features, diagnosis, and treatment of the dorsoulnar TFCC injury, a new type of TFCC lesion that is not included in the Palmer’s classification. Patients And Methods We investigated 68 patients with dorsoulnar TFCC injuries treated with wrist arthroscopy-assisted suture anchor repair. A retrospective review of all cases was performed to assess the clinical manifestations, physical examination, magnetic resonance imaging, and intraoperative findings. In addition, patients were evaluated at greater than 1 year with a range of motion, grip strength, standard outcome measures.Before and after surgery, we measured subjective results using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The functional outcome was calculated by the Mayo Wrist Score.And a survey assessing return to work and sports. Results All patients complained of dorsoulnar side wrist pain before surgery. Most of them got a history of trauma, which was not very drastic. The mean age of the patients (30 male and 38 female) at the time of surgery was 39.72 ± 12.6 years. No major complications occurred during surgery and follow-up. Pain perception (VAS: preoperatively 2.96 ± 1.01 vs. Postoperatively 0.09 ± 0.29, p < 0.05) improved significantly. The result of grip strength (preoperatively 25.92 ± 7.18 vs. postoperatively 34.25 ± 10.43, p < 0.05) was satisfactory after surgery. The percentage of grip strength on the affected side compared with that on the healthy side was 0.79 ± 0.10. The DASH score improved significantly (preoperatively 47.98 ± 10.31 vs. Postoperatively 6.35 ± 4.53, p < 0.05). The mean Mayo Wrist Score was 89.41 ± 8.26 at follow-up. Overall, the wrist functions of 59 (86.76%) (excellent: 31, Good: 28) of the patients were satisfactory according to their modified Mayo wrist scores. There was 1 Suture anchor loosening that required repeat surgery. There were no cases of distal radioulnar joint instability at the final follow-up. Conclusions Dorsoulnar damage of the TFCC is not so rare in clinical settings. The combination of clinical manifestations and preoperative physical examination maneuvers, preoperative MR images, and arthroscopic observation provide a definite diagnosis of this type of TFCC injury. We name this new pattern of injury as Palmer 1E lesion. Furthermore, the repair of this type of TFCC tears using suture anchors assisted by wrist arthroscopies is safe and simple with good results.