Sprain of the triangular fibrocartilage disc ligament (TFCC) at the wrist – definition:
Among severe wrist sprains, TFCC ligament lesions are the most common.
This wrist ligament consists of a fibrocartilage structure that is not vascularised on its radial aspect. As a result, only lesions located on the ulnar aspect of the wrist can be repaired durably. This sophisticated wrist surgery is specialist surgery.
Video of arthroscopic surgery on sprained wrist:
Diagnosis of TFC lesion at the wrist:
In wrist sprains, the most frequent complaint reports pain in resistive prono-supination movements of the wrist.
This frontal section CT arthrography of the wrist shows an ulnar tear of the TFCC ligament, with a leak of the contrast agent into the distal radioulnar joint.
Arthroscopic TFC repair procedure:
This surgery is arthroscopic and performed on an outpatient basis under locoregional anaesthesia. The wrist is positioned vertically under light traction so as to achieve decoaptation of the wrist’s joint.
Only three 2-mm incisions on the dorsal and ulnar aspects of the wrist are necessary.
The surgical procedure consists first in assessing the lesions through the radiocarpal optical portal. An old tear is found, with loss of the trampoline effect and inflamed wrist synovitis opposite. The lesion is then debrided using a shaver under arthroscopic monitoring.
To reattach the ligament, an ulnar path is then used: two needles are introduced on either side of the ulnar styloid through the TFCC.
Two threads are passed through the needles and secondarily retrieved so as to form a U stitch that will be put under tension so as to reattach the disc to the inner capsule surface. The threads are then tied on the ulnar side of the wrist, with the stitch secured using the styloid.
Repair strength and trampoline effect restoration are confirmed, the latter being essential to wrist function.
The micro-incisions in the wrist are closed using Steri-strip.
Recovery after arthroscopic repair of the TFC:
Wrist immobilization with a removeable splint will be necessary for 5 weeks.
Wrist scars are hardly visible after one month and most of the time invisible after at months.
Rugby resumes at 2 to 3 months.