Universität zu Köln

Moeldner, Meike, Unglaub, Frank, Hahn, Peter, Mueller, Lars P., Bruckner, Thomas and Spies, Christian K. (2015). Functionality After Arthroscopic Debridement of Central Triangular Fibrocartilage Tears With Central Perforations. J. Hand Surg.-Am. Vol., 40 (2). S. 252 - 259. PHILADELPHIA: W B SAUNDERS CO-ELSEVIER INC. ISSN 1531-6564

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Abstract

Purpose To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length. Methods Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). Results Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement. Conclusions Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar-sided wrist pain after debridement who had preoperative static positive ulnar variance of 1.8 mm or more may be treated by ulnar shortening earlier in order to spare them prolonged symptoms. (Copyright (C) 2015 by the American Society for Surgery of the Hand. All rights reserved.)

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Moeldner, Meike UNSPECIFIED UNSPECIFIED UNSPECIFIED Unglaub, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Hahn, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Lars P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruckner, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Spies, Christian K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-413392
DOI:	10.1016/j.jhsa.2014.10.056
Journal or Publication Title:	J. Hand Surg.-Am. Vol.
Volume:	40
Number:	2
Page Range:	S. 252 - 259
Date:	2015
Publisher:	W B SAUNDERS CO-ELSEVIER INC
Place of Publication:	PHILADELPHIA
ISSN:	1531-6564
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ULNAR SHORTENING OSTEOTOMY; DISTAL RADIOULNAR JOINT; PARTIAL EXCISION; OUTCOME MEASURE; FOLLOW-UP; COMPLEX; WRIST; VARIANCE; LESIONS; QUESTIONNAIRE Multiple languages Orthopedics; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/41339