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Handchir Mikrochir Plast Chir 2022; 54(05): 389-398
DOI: 10.1055/a-1872-0109
Original Article

Differentiated Approaches to Treat Lesions of the TFCC Based on new arthroscopic Classification

Differentialtherapie von TFCC-Läsionen basierend auf einer neuen arthroskopischen Klassifikation
Toshiyasu Nakamura
1   Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Tokyo, Japan
2   Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
,
Takehilko Takagi
2   Department of Orthopaedic Surgery, National Center for Child Health and Development, Setagaya-ku, Japan
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Abstract

In this article, pathology of the TFCC lesions, image diagnosis and arthroscopic examination were described. According to the radiocarpal arthroscopic findings, TFCC lesions are classified into intra-disc lesions (Class 1), radial lesion (Class 2), peripheral disc lesions which indicate slight to moderate DRUJ instability (Class 3) and degenerative lesion (Class 4). The radioulnar ligament (RUL) lesions that indicate moderate to severe DRUJ instability were classified with staging system with DRUJ arthroscopic findings (Stage 1 to 5). Author’s treatment algorism with wrist arthroscopic findings including DRUJ arthroscopy was demonstrated and along with this algorism, various arthroscopic and open techniques to treat TFCC injuries were selected and resulted in success. Precise diagnosis of the TFCC lesions helped to select an adequate treatment for each lesion.

Zusammenfassung

Dieser Artikel beschreibt die pathologischen Veränderungen des TFCC sowie deren Befunde in der Bildgebung und Arthroskopie. Am TFCC lassen sich mittels Arthroskopie bei Sicht von radiokarpal zentrale (Typ 1), radiale (Typ 2) sowie periphere Läsionen (Typ 3), die mit einer moderaten Instabilität des distalen Radioulnargelenkes (DRUG) einhergehen, und degenerative Läsionen (Typ 4) unterscheiden. Läsionen der radioulnaren Bänder, die mit einer moderaten bis ausgeprägten Instabilität des DRUG vergesellschaftet sind, werden anhand der Befunde bei der DRUG-Arthroskopie in fünf Stadien eingeteilt. Diesen unterschiedlichen Befunden angepasst wurde ein Behandlungsalgorithmus mit verschiedenen arthroskopischen und offenen Verfahren entwickelt, der sich als erfolgreich erwies. Eine exakte Klassifizierung von TFCC-Läsionen ermöglicht die Wahl des für die jeweilige Läsion adäquaten Therapieverfahrens.

Key words

Triangular fibrocartilage complex - arthroscopic exploration - arthroscopic repair - open repair - reconstruction

Schlüsselwörter

Triangulärer fibrokartilaginärer Faserknorpel - arthroskopische Untersuchung - arthroskopische Behandlung - offene Behandlung - Rekonstruktion


Publication History

Received: 22 May 2022

Accepted: 23 May 2022

Article published online:
29 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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