Abstract
Radial-sided avulsions of the TFCC (Palmer 1d) remain a challenging pathology to treat. No current procedures have addressed these injuries successfully and reproducibly. Ten preserved dissected cadaveric forearm specimens with intact TFCC and without ulnar positive variance underwent biomechanical testing. Specimens were tested intact, then with Palmer 1d TFCC lesion and finally post-reconstruction. Measurement of total displacement with a −20N to 20N load was performed. The results indicate that our novel anatomic intra-articular reconstruction of unstable radial-sided TFCC avulsions was successful in restoring baseline stability to the DRUJ without interfering with pronation or supination.
Radial-sided avulsions of the TFCC (Palmer 1d) remain a challenging pathology to treat. No current procedures have addressed these injuries successfully and reproducibly. We tested a novel intra-articular reconstruction to address unstable radial-sided TFCC avulsions.
Ten preserved dissected cadaveric forearm specimens with intact TFCC and without ulnar positive variance underwent biomechanical testing using an MTS machine. Measurement of total displacement with a −20N to 20N load was performed. Specimens were tested intact, then with Palmer 1d TFCC lesion and finally post-reconstruction. All tests were performed at neutral, maximal pronation and maximal supination.
Mean total displacements of the specimens at neutral rotation were: 4.122mm ± 0.363 for the intact specimens compared to 11.839mm ± 0.782 after creation of the tear (p< 0.000002) and 3.883mm ± 0.655 for the reconstructed specimens (p=0.77). In maximal pronation mean total displacements were: 2.378mm ± 0.250 intact vs. 4.922 ± 0.657 torn (p< 0.0007) and 2.124mm ± 0.339 post-reconstruction (p=0.61). In maximal supination mean total displacements were: 1.438mm ± 0.222 intact vs. 5.704mm ± 1.258 torn (p< 0.006) and 1.004mm ± 0.091 post-reconstruction (p=0.07). All specimens obtained the same maximal pronation and supination pre and post-reconstruction.
Restoration of stability and joint function have never been achieved with previous reconstruction attempts of radial-sided TFCC avulsions. Current procedures are unable to restore DRUJ stability without a significant sacrifice of motion. Our anatomic intra-articular reconstruction of unstable radial-sided TFCC avulsions succeeded in restoring baseline stability to the DRUJ without interfering with pronation/supination.
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
