Highlights
- •TFCC rehabilitation following foveal repair surgery was inconsistently reported.
- •TFCC rehabilitation protocols varied between the included studies.
- •Adverse events were rarely reported to have occurred.
- •No study provided any supporting literature to justify rehabilitation recommendations.
Abstract
Study Design
Scoping review.
Background
Rehabilitation guidelines following triangular fibrocartilage complex (TFCC) foveal
repair surgery have been inconsistently reported in the published literature, with
no consensus regarding wrist or forearm range of motion (ROM) commencement time.
Purpose of the Study
To scope the available literature to identify the extent and strength of the evidence
supporting the clinical guidelines for wrist and forearm ROM commencement time following
primary TFCC foveal repair surgery.
Methods
A systematic search produced 26 studies (3 retrospective cohort studies, 1 prospective
cohort study, 1 retrospective comparative study, and 21 retrospective case series)
that described specific rehabilitation protocols following TFCC foveal repair surgery.
Results
No supporting evidence was identified regarding rehabilitation protocol recommendations
across all the included studies. Postsurgery wrist ROM commencement ranged from 2
to 8 weeks; forearm ROM commencement ranged from 2 to 12 weeks. ROM commencement times
did not appear to systematically influence the rate of adverse events, although adverse
events were poorly reported.
Conclusions
TFCC rehabilitation protocols were poorly reported and varied widely between the included
studies. Additional research is recommended to comprehensively evaluate the association
between wrist and/or forearm ROM and the rate of adverse events for this complex and
multifaceted condition.
Keywords
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References
- The triangular fibrocartilage complex of the wrist: anatomy and function.J Hand Surg Am. 1981; 6: 153-162
- Functional anatomy of the triangular fibrocartilage complex.J Hand Surg Eur. 1996; 21: 581-586
- The effect of triangular fibrocartilage complex tear on wrist proprioception.J Hand Surg Am. 2018; 43 (866.e861-866.e868)
- Force distribution across wrist joint: application of pressure-sensitive conductive rubber.J Hand Surg Am. 1992; 17: 339-347
- Intra-articular pressure measurement in the radioulnocarpal joint using a novel sensor: in vitro and in vivo results.J Hand Surg Am. 2007; 32: 67-75
- Foveal TFCC tear classification and treatment.Hand Clin. 2011; 27: 263-272
- Update TFCC: histology and pathology, classification, examination and diagnostics.Arch Orthop Trauma Surg. 2015; 135: 427-437
- Distal radius fractures: current concepts.J Hand Surg Am. 2012; 37: 1718-1725
- Intraarticular lesions in distal fractures of the radius in young adults: a descriptive arthroscopic study in 50 patients.J Hand Surg Eur. 1997; 22: 638-643
- Epidemiology of distal radius fractures and factors predicting risk and prognosis.J Hand Ther. 2016; 29: 136-145
- Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia.J Trauma Acute Care Surg. 2003; 55: 87-93
Australian Bureau of Statistics. 2021.
- Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU).Curr Rev Musculoskelet Med. 2017; 10: 53-61
- Elite athlete: chronic DRUJ instability or central TFC tears.Hand Clin. 2012; 28: 341-342
- The treatment of TFCC injuries in football players.Hand Clin. 2012; 28: 327
- Central TFCC tears in baseball players.Hand Clin. 2012; 28: 339
- The prevalence, variety and impact of wrist problems in elite professional golfers on the European Tour.Br J Sports Med. 2013; 47: 1075-1079
- Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3T.Magn Reson Imaging. 2013; 31: 221-226
- Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists.J Hand Surg Am. 2012; 37: 98-103
- Histological anatomy of the triangular fibrocartilage complex of the human wrist.Ann Anat. 2000; 182: 567-572
- The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex.Curr Probl Diagn Radiol. 2016; 45: 39-50
- Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years.J Hand Surg Am. 2007; 32: 1086-1106
- Triangular fibrocartilage complex lesions: a classification.J Hand Surg Am. 1989; 14: 594-606
- Ulnar-sided wrist pain: diagnosis and treatment.J Bone Joint Surg Am. 2004; 86: 1560-1574
- Arthroscopic foveal repair of the triangular fibrocartilage complex.J Wrist Surg. 2015; 4: 22-30
- Ligament injury and healing: an overview of current clinical concepts.J Prolotherapy. 2011; 3: 836-846
- Disability and function after arthroscopic repair of ulnar avulsions of the triangular fibrocartilage complex of the wrist.Acta Orthop Belg. 2005; 71: 289-293
- Ligament injury and repair: current concepts.Hong Kong Physiother J. 2002; 20: 22-29
- ACL rehabilitation progression: where are we now?.Curr Rev Musculoskelet Med. 2017; 10: 289-296
- Healing of muscle, ligaments, and tendons.in: Paper presented at: Semin Vet Med Surg. (Small Anim). 1989
- Medial collateral ligament healing: a multidisciplinary assessment in rabbits.Am J Sports Med. 1983; 11: 379-389
- Treatment of the medial collateral ligament injury: II: structure and function of canine knees in response to differing treatment regimens.Am J Sports Med. 1987; 15: 22-29
- Flexor tendon healing and restoration of the gliding surface: an ultrastructural study in dogs.J Bone Joint Surg Am. 1983; 65: 70-80
- Arthroscopic repair of triangular fibrocartilage tears: a biomechanical comparison of a knotless suture anchor and the traditional outside-in repairs.J Hand Surg Am. 2013; 38: 2193-2197
- All-arthroscopic triangular fibrocartilage complex repair: safety and biomechanical comparison with a traditional outside-in technique in cadavers.J Hand Surg Am. 2009; 34: 671-676
- Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments.J Hand Surg Am. 2003; 28: 622-627
- Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint: a biomechanical study.J Hand Surg Eur. 2013; 38: 515-522
- Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study.J Hand Surg Eur. 2019; 44: 572-581
- An evidence-based approach to scoping reviews.Worldviews Evid Based Nurs. 2016; 13: 118-123
- Scoping studies: towards a methodological framework.Int J Soc Res Methodol. 2005; 8: 19-32
Peters M, Godfrey C, McInerney P, Soares C, Khalil H, Parker D. The Joanna Briggs Institute reviewers' manual 2015: methodology for JBI scoping reviews. 2015.
- Level of evidence in wrist ligament repair and reconstruction research: a systematic review.J Exp Orthop. 2018; 5: 1-8
- Scoping studies: advancing the methodology.Implement Sci. 2010; 5: 69
- PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation.Ann Intern Med. 2018; 169: 467-473
- Rules of evidence and clinical recommendations on the use of antithrombotic agents.Chest. 1986; 89: 2S-3S
- Midterm results after open versus arthroscopic transosseous repair for foveal tears of the triangular fibrocartilage complex.J Wrist Surg. 2018; 7: 292-297
- Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears.J Hand Surg Am. 2008; 33: 675-682
- Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy.J Hand Surg Am. 2010; 35: 1607-1613
- Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability.J Hand Surg Eur. 2014; 39: 845-855
- Clinical outcomes and factors influencing these outcome measures resulting in success after arthroscopic transosseous triangular fibrocartilage complex foveal repair.Arthroscopy. 2019; 35: 2322-2330
- Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: clinical and radiographic outcomes at 4 years’ mean follow-up.Hand Surg Rehabil. 2020; 39: 193-200
- Suture welding for arthroscopic repair of peripheral triangular fibrocartilage complex tears.Tech Hand Up Extrem Surg. 2007; 11: 45-50
- Short-term evaluation of arthroscopic outside-in repair of ulnar side TFCC tear with vertical mattress suture.J Orthop. 2016; 13: 455-460
- Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears.J Hand Surg Eur. 2003; 28: 546-550
- New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies.Arthroscopy. 1996; 12: 699-703
- Arthroscopically assisted transosseous triangular fibrocartilage complex foveal tear repair in the United States military.J Hand Surg Am. 2019; 1: 79-84
- Arthroscopic repair of triangular fibrocartilage complex tears.Arthroscopy. 2007; 23 (e721): 729-737
- Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique.Scand J Plast Reconstr Surg Hand Surg. 1999; 33: 439-447
- Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study.Arthroscopy. 2011; 27: 1371-1378
- Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient.Arthroscopy. 2013; 29: 1762-1768
- Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist.Chir Main. 2002; 21: 298-300
- Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear.Arch Orthop Trauma Surg. 2018; 138: 131-138
- Arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears.Arthroscopy. 2008; 24: 1244-1250
- Prognostic factors for the outcome of arthroscopic capsular repair of peripheral triangular fibrocartilage complex tears.Arch Orthop Trauma Surg. 2018; 138: 1741-1746
- Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome.Arthroscopy. 2005; 21: 1126-1130
- Long-term outcomes of all-arthroscopic pre-tied suture device triangular fibrocartilage complex repair.J Wrist Surg. 2019; 8: 403-407
- Arthroscopically assisted repair of triangular fibrocartilage complex foveal tears.J Hand Surg Am. 2013; 38: 271-277
- Arthroscopic repair of ulnar-sided triangular fibrocartilage complex (palmer type 1B) tears: a comparison between short- and midterm results.J Hand Surg Am. 2012; 37: 2325-2330
- All-arthroscopic repair of palmer 1B triangular fibrocartilage complex tears using the fast-fix device.J Hand Surg Am. 2011; 36: 836-842
- Comparison of forearm rotation allowed by different types of upper extremity immobilization.J Bone Joint Surg Am. 2012; 94: 455-460
- The effect of short arm cast length on forearm rotation.J Hand Surg Am. 2014; 39: 629-633
Splint classification system. The Society; 1992.
- A history of splinting: to understand the present, view the past.J Hand Ther. 2002; 15: 97-132
- Progression models in resistance training for healthy adults.Med Sci Sports Exerc. 2009; 41: 1351
- Proprioception of the wrist joint: a review of current concepts and possible implications on the rehabilitation of the wrist.J Hand Ther. 2010; 23: 2-17
- Chronic scapholunate interosseous ligament disruption: a systematic review and meta-analysis of surgical treatments.Hand. 2020; 15: 27-34
- Biomechanics of the distal radioulnar joint.J Bone Joint Surg Am. 1984; 187: 26-35
- Single screening versus conventional double screening for study selection in systematic reviews: a methodological systematic review.BMC Med Res Methodol. 2019; 19: 1-9
- Reliability and validity of the upper limb DASH questionnaire in patients with distal radius fractures.Z Orthop Ihre Grenzgeb. 2002; 140: 447-451
- Reliability and validity of the German version of “the Patient-rated Wrist Evaluation (PRWE)” as an outcome measure of wrist pain and disability in patients with acute distal radius fractures.J Hand Ther. 2008; 21: 366-376
Article info
Publication history
Published online: December 29, 2021
Accepted:
October 2,
2021
Received in revised form:
August 8,
2021
Received:
February 17,
2021
Publication stage
In Press Corrected ProofFootnotes
Financial disclosure statement: None of the authors have a financial interest in the completion of this scoping review.
Competing or conflict of interest statement: This scoping review was conducted by the corresponding author as part of a higher degree by research under supervision from the listed co-authors. None of the authors have any additional conflict of interests to declare.
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