Document Detail


A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome.
MedLine Citation:
PMID:  15067279     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Treatment of ulnocarpal abutment (UAS) syndrome involves decompression of the pressure and impingement, or abutment of the ulnocarpal articulation. Debridement of triangular fibrocartilage complex (TFCC) tears alone in the patient with UAS may have a failure rate of as much as 25% to 30%. Ulnar shortening osteotomy (USO) can be an effective treatment of failed TFCC debridement. Good results have been reported with combined arthroscopic TFCC debridement and mechanical arthroscopic distal ulnar resection. Similar results have been reported with both ulnar shortening osteotomy and open wafer distal ulnar resections in the UAS patient. Because all of these treatment choices appear to yield similar relief of symptoms, determination of the optimal treatment protocol remains a point of debate. The purpose of this study was to evaluate 2 different surgical treatments for UAS. TYPE OF STUDY: Retrospective review. METHODS: Eleven combined arthroscopic TFCC debridement and arthroscopic distal ulna resections (arthroscopic wafer procedures; AWP) were compared with 16 arthroscopic TFCC debridement and USOs. All patients had diagnostic wrist arthroscopy and arthroscopic TFCC debridement. All patients presented with ulnar wrist pain or neutral or positive ulnar variance, and all experienced at least 3 months of failed conservative management. RESULTS: At mean follow-up times of 21 and 15 months, respectively, 9 of 11 patients showed good to excellent results after arthroscopic TFCC debridement and AWP compared with 11 of 16 after arthroscopic TFCC debridement and USO. A statistically significant difference (P <.05) in the complication rates was identified, including secondary procedures and tendonitis. One secondary procedure and 2 cases of tendonitis were seen in the arthroscopic wafer group. CONCLUSIONS: Combined arthroscopic TFCC debridement and arthroscopic wafer procedure provides similar pain relief and restoration of function with fewer secondary procedures and tendonitis when compared with arthroscopic TFCC debridement and USO, for the treatment of UAS. LEVEL OF EVIDENCE: Level III.
Authors:
Matthew A Bernstein; Daniel J Nagle; Alicia Martinez; John M Stogin; Thomas A Wiedrich
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Review    
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  20     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-06     Completed Date:  2004-07-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  392-401     Citation Subset:  IM    
Affiliation:
Department of Orthopedic Surgery, Alexian Brothers and St. Alexius Medical Centers and Barrington Orthopedic Specialists and Sports Medicine, Hoffman Estates, Illinois 60195, USA. mattbern@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arthroscopy / methods*
Carpal Bones*
Cartilage Diseases / etiology,  surgery*
Cartilage, Articular / injuries,  surgery*
Debridement / methods*
Female
Hand Strength
Humans
Ligaments, Articular / injuries,  surgery
Male
Middle Aged
Osteotomy / methods*
Postoperative Complications / epidemiology,  etiology
Retrospective Studies
Syndrome
Tendinopathy / epidemiology,  etiology
Treatment Outcome
Ulna / surgery*
Wrist Injuries / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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