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Meniscus and discus lesions of triangular fibrocartilage complex (TFCC): treatment by laser-assisted wrist arthroscopy

Manfred Infanger, Daniela Grimm
Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS 2009, 62 (4): 466-71

BACKGROUND: Meniscus and disc lesions in the triangular fibrocartilage complex (TFCC) are generally caused by falling accidents with pronated, hyperextended wrists, or by distraction injuries that pull the ulnar side of the wrist out of place. Characteristic clinical signs are swelling and pain in the distal radioulnar joint (DRUJ) and a 'clicking' noise in the meniscus lesion. If untreated, loss of mobility and grip strength as well as progressive arthritic changes ensue. We investigated in this study the laser-assisted arthroscopic debridement of the central TFCC and meniscus to compare the advantages and disadvantages of such treatment to conventional arthroscopic debridement.

PATIENTS AND METHODS: Seventy-two patients underwent laser-assisted arthroscopic debridement of traumatic TFCC tears (meniscus and disc). Patients with TFCC tears that were associated with fractures, significant bone or neurovascular pathology or DRUJ instability were excluded from the study. The mean age was 32.4 years; 28 female and 51 male patients were included in the study. The mean follow up was 25.6 months. First of all, we evaluated the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. We then applied the range of motion of the hand (ROM) as second variable during statistical analysis to identify outcome.

RESULTS: There were no complications after surgery. No instabilities or dislocations of the DRUJ were noted. The postoperative DASH score indicated that the laser-assisted arthroscopic repair of traumatic peripheral TFCC tears resulted in a very good functional outcome. All patients with isolated meniscus homologue tears were without pain after the operation. At final follow up, the ROM was equal to or greater than that of the contralateral side.

CONCLUSION: We have demonstrated that the TFCC laser debridement technique is easy and safe to perform. The outcome was excellent with less pain and good ROM. In particular, the laser technique enabled a good intra-articular haemostasis and allowed an exact tear debridement.

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