ARTIGO DO MÊS (9/2009)

Arthroscopic Treatment of Triangular Fibrocartilage Wrist Injuries in the Athlete

Timothy R. McAdams, Justin Swan and Jeffrey Yao
Am J Sports Med 2009 37: 291 - 297

Abstract

Background: Triangular fibrocartilage (TFC) injuries are an increasingly recognized cause of ulnar-sided wrist pain and can be particularly disabling in the competitive athlete. Previous studies show that arthroscopic debridement or repair can improve symptoms, but the results of arthroscopic treatment of TFC injuries in high-level athletes have not yet been reported.

Hypothesis: Arthroscopic debridement or repair of wrist TFC injury will allow a high rate of return to full function in the elite athlete.

Study Design: Case series; Level of evidence, 4.

Methods: Between 2001 and 2005, 16 competitive athletes (mean age, 23.4 years) with wrist TFC injuries underwent arthroscopic surgery. Repair was performed in unstable tears, and all others underwent debridement alone. Presurgery and postsurgery mini-DASH (Disabilities of the Arm, Shoulder, and Hand) scores were recorded for each athlete through medical record review and clinical evaluation. The mean duration of follow-up was 32.8 months (range, 24-51 months).

Results: The TFC was repaired in 11 (68.8%) and debrided in 5 (31.3%) patients. The tear was ulnar-sided in 12 (75%), radialsided in 2 (12.5%), combined radial-ulnar in 1, and central-sided in 1 patient. Mean mini-DASH scores improved from 47.3 (range, 25-65.9) to 0 (all patients), and the mean mini-DASH sports module improved from 79.7 to 1.95. Return to play averaged 3.3 months (range, 3-7 months). Associated conditions in the 2 patients unable to return to play at 3 months were distal radioulnar joint (DRUJ) instability with ulnar-carpal abutment (n = 1) and extensor carpi ulnaris (ECU) tendinosis (n = 1).

Conclusion: Arthroscopic debridement or repair of wrist TFC injury provides predictable pain relief and return to play in competitive athletes. Return to play may be delayed in athletes with concomitant ulnar-sided wrist injuries.

Keywords: triangular fibrocartilage; tear; arthroscopy; athlete; repair