Sprain of the triangular fibrocartilage disc (TFCC ligament) at the wrist

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:

Video of arthroscopic wrist surgery with repair on severe TFCC sprain / Toulouse specialist 

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.

Surgery of severe wrist sprain by ulnar rupture of the TFCC ligament, preoperative CT arthrography, ToulouseSurgery of severe wrist sprain by ulnar rupture of the TFCC ligament, preoperative CT arthrography, Toulouse

 

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.

Arthroscopic wrist sprain surgery, operative setup, Toulouse

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.

Surgery of severe wrist sprain by ulnar tear of the TFCC, loss of trampoline effect induced by tear, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC, debridement of lesion with a shaver, Toulouse

To reattach the ligament, an ulnar path is then used: two needles are introduced on either side of the ulnar styloid through the TFCC.

Surgery of severe wrist sprain by ulnar rupture of the TFCC, introduction of 2 needles, ToulouseSurgery of severe wrist sprain by ulnar rupture of the TFCC, thread being passed through each needle, Toulouse

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.

Surgery of severe wrist sprain by ulnar rupture in the TFCC, retrieval of sutures, ToulouseSurgery of severe wrist sprain by ulnar tear of the TFCC, reattachment being put under tension, Toulouse

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.

Surgery of severe wrist sprain by ulnar rupture of the TFCC. Postoperative immobilization lasts 5 weeks, ToulouseSurgery of severe wrist sprain by ulnar rupture of the TFCC, scar at 1 month, Toulouse

Rugby resumes at 2 to 3 months.

Surgery of severe wrist sprain by ulnar rupture of the TFCC, rugby resumes at 3 months, Toulouse