Most high-level athletes return to sport 3 months after arthroscopic TFC surgery

Arthroscopically debriding or repairing elite athletes’ triangular fibrocartilage wrist injuries often enabled them to quickly return to competitive play, according to investigators who treated and followed these patients.

Investigators based their decision whether to debride or treat these injuries solely on the location and stability of the triangular fibrocartilage (TFC) tears, Timothy R. McAdams, MD, of Stanford University, Palo Alto, Calif., said.

During the American Orthopaedic Society of Sports Medicine 2008 Annual Meeting in Orlando, Fla., he presented results of the study he conducted with Justin Swan, MD.

“Arthroscopic repair of injury to the triangular fibrocartilage is successful treatment for the high-level athlete who failed nonoperative management,” McAdams said. Based on his study results, he recommended allowing 6 weeks for the repair to fully heal.

McAdams and Swan arthroscopically treated 16 competitive athletes’ TFC wrist injuries between 2001 and 2005 (mean age 23.4 years, range 16-42 years).

Most injuries occurred in the patients’ dominant extremity. All but two patients were professional or Division I college athletes involved in gymnastics, tennis, football or other throwing sports, McAdams said.

Investigators hypothesized “arthroscopic debridement or repair of the TFC injury will allow a high rate of return to full function in the elite athlete,” he said.

Patients were offered 6 weeks of nonoperative care consisting of splinting, rehabilitation or cortisone injections prior to surgery. Preoperatively and at 3 months postoperatively, investigators obtained patients’ mini-DASH scores.

“The arthroscopy involved a repair of the TFC if it was unstable or peripheral and a debridement if it was stable or central,” McAdams explained.

Although investigators diagnosed associated conditions in about 25% of patients, they did not perform any associated procedures at the time of arthroscopic surgery.

Postoperatively investigators placed patients in short arm casts for up to 6 weeks, followed by a physical therapy regimen. They then followed the patients 32.75 months (mean).

“Mini-DASH scores reflect activities of daily living with 47.3 preop and 0 postop,” McAdams said. This difference was significant. Mini-DASH sports-related scores were 79.7 preoperatively vs. 1.95 postoperatively, which also represented a significant improvement, he said.

Average return to play was 3.25 months (ranging from 3 to 7 months); however, two patients did not return to sport by 3 months due to distal radial ulnar joint (DRUJ) instability in conjunction with ulnocarpal impaction.

“Anticipate return to play at 3 months, although it may be longer with DRUJ instability,” he noted.

For more information:
Timothy R. McAdams, MD, can be reached at 1000 Welch Road, Suite 100, Palo Alto, CA 94304; 650-736-9597; e-mail: tmcadams@stanford.edu. He has no direct financial interest in any products or companies mentioned in this article.

Reference:
McAdams TR, Swan J. Triangular fibrocartilage repair in the elite athlete. Presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting. July 10-13, 2008. Orlando, Fla.