title: Biomechanical Analysis of All-Inside, Arthroscopic Suture Repair Versus Extensor Retinaculum Capsulorrhaphy for Triangular Fibrocartilage Complex Tears With Instability.
abstract: OBJECTIVE
  To assess ulnocarpal joint stability after treatment of a peripheral triangular fibrocartilage complex (TFCC) injury with all-inside arthroscopic suture repair (SR), extensor retinaculum capsulorrhaphy with the Herbert sling (HS), and a combination of both (SR+HS).
  
  
  METHODS
  Twelve fresh-frozen, age-matched, upper-extremity specimens intact from the distal humerus were prepared. Nondestructive mechanical testing was performed to assess native ulnocarpal joint stability and load-displacement curves were recorded. A peripheral, ulnar-sided TFCC injury was created with arthroscopic assistance, and mechanical testing was performed. Each specimen was treated with SR or HS and testing was repeated. The 6 specimens treated with SR were then treated with HS (SR+HS), and testing was repeated. We used paired Student t tests for statistical analysis within cohorts.
  
  
  RESULTS
  For all cohorts, there was an average increase in ulnar translation after the creation of a peripheral TFCC injury and an average decrease after repair. Herbert sling decreased translation by 21%, SR decreased translation by 12%, and SR+HS decreased translation by 26%.
  
  
  CONCLUSIONS
  Suture repair plus HS and HS reduce ulnar translation the most after a peripheral TFCC injury, followed by SR alone.
  
  
  CONCLUSIONS
  Ulnocarpal joint stability should be assessed clinically in patients with peripheral TFCC injury, and consideration should be made for using extensor capsulorrhaphy in isolation or as an adjunct to SR as a treatment option.
authors.affiliation: Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL.
authors.forename: Amar A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Department of Orthopaedics, Jackson Memorial Hospital, University of Miami, Miami, FL. Electronic address: ali.alhandi@gmail.com.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Alhandi
authors.affiliation: Max Biedermann Institute of Biomechanics, Mount Sinai Medical Center, Miami, FL.
authors.forename: Edward
authors.initials: E
authors.lastname: Milne
authors.affiliation: Department of Orthopaedics, Washington University, St. Louis, MO.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.affiliation: Max Biedermann Institute of Biomechanics, Mount Sinai Medical Center, Miami, FL.
authors.forename: Loren L
authors.initials: LL
authors.lastname: Latta
authors.affiliation: Ouellette Group, Miami, FL.
authors.forename: E Anne
authors.initials: EA
authors.lastname: Ouellette
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D051478:Triangular Fibrocartilage / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*
keywords: All-arthroscopic; Herbert sling; capsulorrhaphy; triangular fibrocartilage complex