TFCC tears

In this key lecture, Dr. Van Overstraeten focuses on the scapholunate complex, delineating a new concept.

In this key lecture, Dr. Mantovani covers the predynamic scapholunate instability, as a new entity, and the role of dorsal ganglion etiology.

In this key lecture, Dr. Messina focuses on scapholunate tears and on the importance of their early diagnosis.

In this lecture, Dr. Camus focuses on wrist arthroscopic anatomy.

The arthroscopic resection of dorsal ganglia of the wrist is a safe technique which allows for a satisfactory resection of the cyst and the adjacent articular capsule. There are two different techniques for resection of the dorsal ganglia: either by passing through the radio carpal joint, or directly through the ganglion and through the midcarpal joint. This second technique will be demonstrated in this video. The patients' satisfaction rate is very high, particularly because there is neither cutaneous suture, nor immobilization of the wrist.

Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.

The ulnocarpal conflict is not a rare condition and should be taken into account in the event of ulnocarpal pain. The conflict is created by too narrow a space of the ulnar head and the ulnar edge of the lunate and the triquetrum. During loading and ulnar deviation of the wrist, a direct contact between these bones is produced. This leads to degenerative changes on the cartilage and produces pain. The origin may be a congenital positive ulnar situation, or a trauma impairing the natural leveling of the forearm bones. We distinguish a fresh traumatic condition (ulnar impaction syndrome) from a chronic condition (ulnar impingement syndrome). The midcarpal bones may also suffer from a similar condition, which is the hamate tip syndrome.
Diagnosis is made by clinical examination including the ulnocarpal stress test, standard X-rays, MRI enhanced with endovenous contrast and subsequent wrist arthroscopy.

Therapeutic options include the ulnar shortening osteotomy and the resection of the distal head of the ulna. Decision can be made depending on the state of the TFCC, the age of the patient and the collateral changes in the wrist. If the lesion occurs in young patients without any concomitant lesion, a shortening osteotomy is more often chosen.

In all other conditions, the less invasive choice for the minimal resection of the distal ulnar head is made by arthroscopic and open surgery. The camera is introduced through the 3-4 portal and the burr through the 6R portal. At the beginning, a 3.5 burr —in more trained hands a 4.2 burr— is used to resect about 2-3 mm of the distal ulnar head during supination and pronation movements. Care is taken not to resect the foveal area or the DRUJ.

After the operation, a comfort splint can be adapted for 3-4 days, and immediate physiotherapy is initiated.

In this key lecture, Dr. Haerle outlines DRUJ instability due to irreparable TFCC tear.

Intrinsic (and extrinsic) lesions of the wrist ligaments are common, and their treatment is still controversial. Indeed, conventional open surgery sutures often allow the lesions to stabilize, but may cause stiffness, most often preventing a return to previous physical activities, particularly in athletic patients. The advent of arthroscopy has deeply changed the understanding and the treatment of such lesions. This video presents a severe chronic double lesion of the triangular and scapholunate ligaments, as well as a demonstration of how to suture them using arthroscopic techniques.

In this key lecture, Dr. Rahimtoola covers the principles and history of wrist arthroscopy.