Generalized Joint Laxity Increases the Risk of Recurrence of Distal Radio-Ulnar Joint Instability after Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

Ji Sup Kim; Kyeong-Eon Kim; Shin-Woo Lee; Soyoung Jeon; Hyejin Yang; Yun-Rak Choi

doi:10.1016/j.arthro.2024.10.040

Generalized Joint Laxity Increases the Risk of Recurrence of Distal Radio-Ulnar Joint Instability after Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

Arthroscopy. 2024 Nov 7:S0749-8063(24)00881-8. doi: 10.1016/j.arthro.2024.10.040. Online ahead of print.

Authors

Ji Sup Kim¹, Kyeong-Eon Kim², Shin-Woo Lee², Soyoung Jeon³, Hyejin Yang³, Yun-Rak Choi⁴

Affiliations

¹ Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea; Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
³ Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Orthopaedic Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea. Electronic address: [email protected].

PMID: 39521390
DOI: 10.1016/j.arthro.2024.10.040

Abstract

Purpose: To compare the clinical results of the arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) for distal radio-ulnar joint (DRUJ) instability in patients with or without generalized joint laxity.

Methods: Patients who underwent arthroscopic transosseous foveal TFCC repair of Palmer 1B foveal TFCC tears (Atzei classification class II or III) from January 2018 to October 2021 were identified. Patients treated for symptomatic DRUJ instability for more than 3 months, and with at least 2 years of follow-up, were included. Patients were categorized into two groups based on the Beighton and Horan criteria: those with generalized joint laxity (group L) and those without (group N). Clinical outcomes were measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score (MMWS), wrist range of motion (ROM), grip strength, sports/recreation activity level, recurrent DRUJ instability, and achievement of minimal clinically important differences (MCID).

Results: One-hundred-and-twenty patients (Group L, 51 patients; Group N, 69 patients) were included. Both groups showed significant improvements in preoperative DASH and MMWS at the final follow-up. Overall, 103 patients (85.8%) achieved MCID, with 82.4% in Group L and 88.4% in Group N, and no significant differences between the two groups (P = .347). At the final follow-up, ROM and sports/recreation activity levels were similar between the groups. Significantly, the rates of postoperative DRUJ instability recurrence were 17.7% in group L (9/51) and 5.8% in group N (4/69) (P=0.039). Beighton scores were an independent risk factor for recurrent DRUJ instability in the multivariable analysis (P=0.024; odds ratio=1.62).

Conclusions: Clinical outcomes after arthroscopic TFCC foveal repair in patients with generalized joint laxity are comparable to those without, with 82.4% achieving MCID. Generalized joint laxity impacts DRUJ instability recurrence over a minimum two-year follow-up period.

Level of evidence: Level III, retrospective comparative study.