Arthroscopic physeal-sparing TFCC foveal repair via a single extracapsular transverse bone tunnel in adolescents: a retrospective cohort study

TL;DR

A new surgical technique for repairing wrist injuries in adolescents avoids damaging growth plates and achieves good recovery.

Contribution

A novel physeal-sparing TFCC repair technique using a single extracapsular transverse bone tunnel is introduced and evaluated.

Findings

The technique achieved significant improvements in pain, grip strength, and wrist motion.

No physeal injury or DRUJ instability was observed in the 13 adolescents followed for up to 60 months.

Functional scores like MMWS and DASH showed substantial postoperative improvement.

Abstract

Conventional arthroscopic techniques for triangular fibrocartilage complex (TFCC) foveal repair risk iatrogenic physeal injury in adolescents due to longitudinal oblique bone tunnels traversing the distal ulnar physis. This study evaluates a novel physeal-sparing technique utilizing a single extracapsular transverse bone tunnel to avoid growth plate compromise.

A retrospective cohort study included 13 adolescents (10 males, 3 females; median age 15.0 years, range 13–17) with Palmer 1B TFCC foveal tears confirmed by MRI and arthroscopy. All patients underwent arthroscopic transosseous repair through a horizontal transverse bone tunnel drilled proximal to the physis at the ulnar neck level under fluoroscopic guidance. Outcomes included pain scores (visual analogue scale [VAS]), grip strength ratio (affected/unaffected side), wrist range of motion (ROM), distal radioulnar joint (DRUJ) stability, and functional scores: the Modified Mayo Wrist Score (MMWS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score. Mean follow-up was 29.0 months (range 12–60).

At a mean follow-up of 29.0 months, the median VAS score decreased from 5.0 to 1.0 postoperatively. The mean grip strength ratio improved from 91.3% to 102.9%. Median wrist flexion-extension ROM increased from 130.0° to 134.0°, and median pronation-supination ROM improved from 150.0° to 170.0°. The median MMWS improved from 75.0 to 95.0, and the median DASH score decreased from 31.7 to 4.2. No clinical or radiographic signs of physeal injury (e.g., ulnar shortening, angular deformity) or DRUJ instability were observed.

This fluoroscopically guided physeal-sparing technique achieved anatomical TFCC restoration and functional recovery in adolescents by avoiding the physis through an extracapsular transverse tunnel. The absence of growth-related complications supports its safety, though long-term studies are warranted.

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