La prise en charge des lésions du TFCC chez les adolescents par arthroscopie et mini voie d’abord

Purpose Post-traumatic injury of the triangular fibrocartilagineus complex (TFCC) can result in debilitating wrist problems. Although diagnosis and treatment of these lesions is well described for the adult population, hardly any data exists for this type of injury in young adolescents. Methods Between 2011 and 2014 seven patients between 10 and 14 years of age have consulted our department for posttraumatic ulnar-sided wrist pain. Previous trauma included distal radial fractures with a concomitant fracture of the ulnar styloid, multiple micro-traumas of the wrist and an overuse injury. Clinical evaluation showed tenderness over the TFCC complex, pain on movement and in most cases instability of the distal radio-ulnar joint (DRUJ) with episodes of sub/dislocation in two patients. Pre-operative arthro-MRIs were conducted confirming the pathology in only 3 cases. Therefore, all patients underwent diagnostic arthroscopy of the wrist followed by surgical treatment according to the discovered lesion. The mean age at the time of surgery was 12.9 years. Results Arthroscopy of the wrist confirmed a TFCC lesion in all patients. In 5 cases the injury was classified as Palmer type 1B, once as a combined type 1A/1B and once as type 1A. All 6 patients with a type 1B injury underwent arthroscopically assisted mini-open reconstruction of the TFCC. Treatment of the type 1A injury consisted of arthroscopic shaving of the central lesion. Postoperative clinical examination revealed stable wrists with a normal range of motion in all cases. Patients reported a decrease in pain-level during daily activities or were entirely pain-free. Conclusion TFCC lesions in the adolescent population are difficult to evaluate on an arthro-MRI and results are often inconclusive. Diagnostic arthroscopy is thus the preferred method of diagnosis for this type of injury. The arthroscopic assisted mini-open TFCC reconstruction is a reliable technique to achieve DRUJ stability and good clinical outcomes.