See the published version of this preprint at Journal of Orthopaedic Surgery and Research.
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Technical note
Alvin Chao-Yu Chen
Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, and Chang Gung University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0111-490X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement.
Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably.
Results Operation time averaged 87 minutes. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit.
Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.
Keywords
triangular fibrocartilage complex, distal radioulnar joint, peripheral tear, arthroscopy
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- video2pullout.MP4
Video 2. Percutaneous 2-0 ethibond suture passing through 6U portal was used to check elasticity reparability of the distal component and provisionally approximate the tear gap.
- video3fastfix2.mp4
Video 3. The arthroscope is changed to 6R portal. By keeping the ethibond suture in tension, the polyester suture loop is tightened with a cutter-pusher. Then the arthroscope is shifted back to 3-4 portal with a hook probe from 6R portal to check TFCC stability after repair.
- fastfixvideo1.mp4
Video 1. 29 year-old male patient, left ulnar-sided wrist pain for 24 months after motorbike accident. Arthroscopic viewing from 6R portal shows triquetrum above and TFCC periphery below. A hook probe introduced from 3-4 portal showed partial thickness tear of the distal component; lower part of the distal component remains attached and blocks direct visualization of ulnar head.
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of Orthopaedic Surgery and Research.
No community comments so far
Editorial decision: Accept
On 23 Oct, 2020
Reviewer #1 agreed
On 22 Oct, 2020
Review #1 received
Received 22 Oct, 2020
Reviewers invited
Invitations sent on 19 Oct, 2020
Editor assigned
On 18 Oct, 2020
Submission checks complete
On 17 Oct, 2020
Editor invited
On 17 Oct, 2020
Version 2
Posted 13 Oct, 2020
No comments provided
Review #1 received
Received 06 Oct, 2020
Editor assigned
On 05 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Editorial decision: Major revision
On 05 Sep, 2020
Review #2 received
Received 01 Sep, 2020
Review #1 received
Received 24 Aug, 2020
Reviewer #3 agreed
On 21 Aug, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewer #2 agreed
On 20 Aug, 2020
Editor assigned
On 19 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Editor invited
On 18 Aug, 2020
Submission checks complete
On 18 Aug, 2020
First submitted
On 17 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Journal of Orthopaedic Surgery and Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Technical note
Alvin Chao-Yu Chen
Bone and Joint Research Center, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital-Linkou, and Chang Gung University College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0111-490X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Journal of Orthopaedic Surgery and Research.
No community comments so far
Editorial decision: Accept
On 23 Oct, 2020
Reviewer #1 agreed
On 22 Oct, 2020
Review #1 received
Received 22 Oct, 2020
Reviewers invited
Invitations sent on 19 Oct, 2020
Editor assigned
On 18 Oct, 2020
Submission checks complete
On 17 Oct, 2020
Editor invited
On 17 Oct, 2020
Version 2
Posted 13 Oct, 2020
No comments provided
Review #1 received
Received 06 Oct, 2020
Editor assigned
On 05 Oct, 2020
Reviewers invited
Invitations sent on 05 Oct, 2020
Reviewer #1 agreed
On 05 Oct, 2020
Reviewer #2 agreed
On 05 Oct, 2020
Submission checks complete
On 04 Oct, 2020
Editor invited
On 04 Oct, 2020
No comments provided
Editorial decision: Major revision
On 05 Sep, 2020
Review #2 received
Received 01 Sep, 2020
Review #1 received
Received 24 Aug, 2020
Reviewer #3 agreed
On 21 Aug, 2020
Reviewer #1 agreed
On 20 Aug, 2020
Reviewer #2 agreed
On 20 Aug, 2020
Editor assigned
On 19 Aug, 2020
Reviewers invited
Invitations sent on 19 Aug, 2020
Editor invited
On 18 Aug, 2020
Submission checks complete
On 18 Aug, 2020
First submitted
On 17 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Journal of Orthopaedic Surgery and Research.
Background The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement.
Methods Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than one year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a “visualization test”, and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably.
Results Operation time averaged 87 minutes. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit.
Conclusions A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- video2pullout.MP4
Video 2. Percutaneous 2-0 ethibond suture passing through 6U portal was used to check elasticity reparability of the distal component and provisionally approximate the tear gap.
- video3fastfix2.mp4
Video 3. The arthroscope is changed to 6R portal. By keeping the ethibond suture in tension, the polyester suture loop is tightened with a cutter-pusher. Then the arthroscope is shifted back to 3-4 portal with a hook probe from 6R portal to check TFCC stability after repair.
- fastfixvideo1.mp4
Video 1. 29 year-old male patient, left ulnar-sided wrist pain for 24 months after motorbike accident. Arthroscopic viewing from 6R portal shows triquetrum above and TFCC periphery below. A hook probe introduced from 3-4 portal showed partial thickness tear of the distal component; lower part of the distal component remains attached and blocks direct visualization of ulnar head.
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