Common Thread between the Wrist and KneeWrist injuries are commonly a result of trauma, such as a sports injury. These injuries are named according to location. Other wrist injuries occur as a result of aging and the degenerative changes that come with it. These are named both by location and severity.
Many surgeons are particularly interested in wrist injuries involving the triangular fibrocartilage complex (TFCC). This structure is as complex as it sounds. The TFCC is a maze of cartilage and ligaments where the ulna bone on the inside edge of the forearm meets the small bones of the wrist. Tough, fibrous structures weave around and between the bones to hold everything together yet still allow movement.
The TFCC plays an important part in the workings of the wrist and the entire arm. Heavy and repeated wrist actions cause significant forces through the TFCC and upward into the forearm. Any change in the bones and ligaments in this area can cause problems.
A tear in which the TFCC pulls away from the end of the ulna bone is called a "Class 1B" tear. Surgery to repair this kind of tear has been a challenge for surgeons. It requires threading numerous sutures and tying many knots inside the joint, which makes the procedure time consuming. In addition, damage to the nearby tendons and nerves can occur.
A group of German surgeons used a procedure for repairing knees and adapted it for repairing tears of the TFCC. The new method only takes five minutes and avoids any risk to the nearby tendons and nerves. Surgeons use a simple clip or T-shaped device normally used to hold the cartilage in the knee together.
This procedure can be done using an arthroscope, an instrument that inserts into the joint. The arthroscope has a tiny TV camera on the end that lets doctors see inside the joint. This allows surgeons to pass the fixation device into the wrist without having to open the wrist joint. This little device also eliminates all the sutures and knots that were such a problem.
Doctors are always looking for ways to improve surgical procedures. With the help of an arthroscope and a clip previously used in knee surgery, wrist surgery for TFCC tears can be reduced from 30 to five minutes with virtually no complications.
Gerhard BÃ¶hringer, MD, et al. A Method For All-Inside Arthroscopic Repair of Palmer 1B Triangular Fibrocartilage Complex Tears. In Arthroscopy. February 2002. Vol. 18. No. 2. Pp. 211-213.
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