Single-strand repair of EWAS 1 lesion of triangular fibrocartilage complex
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ORIGINAL ARTICLE
Single‑strand repair of EWAS 1 lesion of triangular fibrocartilage complex Ramy Ahmed Soliman1 · Mohamed Mostafa El‑Mahy1 · Ahmed Naeem Atiyya1 · Khaled M. Emara1 · Tamer Ahmed Fayyad1 · Mohamed Hassan Sobhy1 · Ramy Ahmed Diab1 Received: 8 April 2020 / Accepted: 28 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose To report the results of our modified technique for repair of the EWAS 1 lesion of triangular fibrocartilage complex (TFCC). Methods This retrospective case series reviewed 22 consecutive patients with EWAS 1 TFCC tear. Arthroscopic repair was done using our modified double-loop arthroscopic outside-in technique which is originally described by Mathoulin and Del Piñal. The repair was performed using single-strand suture and 18-gauge cannula, having three passes through the tear. Follow-ups ranged from 24 to 33 months with an average of 29.3 months. The results were evaluated by the Modified Mayo Wrist Score (MMWS), Visual Analog Score (VAS). In addition, range of motion (ROM) and power grip were compared with the contralateral side. Results The mean age was 23 years. The dominant side was affected in 16 wrists. There was postoperative improvement of the all functional outcome measures (MMWS, VAS, ROM, and power grip). All the patients returned to their previous activities with no reported intra- or postoperative complications. Conclusions The described outside-in technique is safe and effective technique for repair of EWAS 1 TFCC tear. Level of evidence Therapeutic, case series, level IV. Keywords Arthroscopic outside-in technique · Arthroscopic repair · Double-loop technique · Triangular fibrocartilage complex tear · Wrist arthroscopy
Introduction The triangular fibrocartilage complex (TFCC) is the major stabilizer of the distal radioulnar joint (DRUJ) [1]. TFCC tears can cause DRUJ instability and functional disability [2]. Tears are categorized into traumatic (Type 1A to 1D) or degenerative (Type 2) according to Palmer classification [3]. Atzei and Luchetti [4] introduced a treatment-oriented classification system that subdivided type 1-B peripheral TFCC tears into five classes. This approach can differentiate distal and proximal components of TFCC tears at its ulnar insertion. The European Wrist Arthroscopy Society (EWAS)
* Ramy Ahmed Soliman [email protected] 1
Orthopedic Surgery, Ain Shams Univeristy, 13 B Kornish El Nile, Agha Khan, Cairo 0020, Egypt
endorsed the classification (EWAS 1–5). EWAS 1 involves an isolated tear of distal component of the TFCC [5]. Because the peripheral 10–40% of the TFCC is highly vascular [6], Arthroscopic techniques (inside-out, outsidein, and all-inside), for peripheral type IB repair, have been described by several authors, with various instrumentations and surgical modifications [7–9] One of the most familiar arthroscopic outside-in techniques used is the double-loop technique described by Mathoulin [10] and del Piñal [11]. Authors developed a technique for arthroscopic outside-in repair o
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