Kendo is a unique martial arts developed in Japan, which represents ancient spirits of Japanese samurai. Instead of Japanese sword, bamboo sword (Shinai) is now used. Point is gained by effective hit to the head “men,” body “dou,” and hand-forearm “kote.” Due to repetitive stress applied on the wrist, lesions in the triangular fibrocartilage complex (TFCC) are popular in kendo players like other racket sports, such as tennis, golf, or baseball.
From 2001 to 2015, 13 kendo players underwent surgical treatment of TFCC injuries in our institute. There were 11 males and 2 females with an average age of 21 (range 15–48). Three right and ten left wrists were involved. Three patients were junior high school students, seven were high school students, one was a university student, and two were teachers. Obvious causes were unknown in all patients, while all claimed difficulties to play kendo due to ulnar-sided wrist pain. Diagnosis of TFCC injury was done by MRI and arthrogram and confirmed with wrist arthroscopy.
Arthroscopic exploration revealed that there were Palmer 1B tear in one wrist, complete rupture of the RUL at the fovea in seven, Palmer 2A tear in four, and 2C in one. Associated injuries were nonunion of the ulnar styloid in three, rupture of the extensor carpi ulnaris (ECU) tendon sheath floor in one, and complete rupture of the ECU tendon in one. Arthroscopic capsular repair was selected for 1B tear, open repair in five, arthroscopic transosseous repair in one, and reconstruction of the TFCC using an ECU half-slip tendon in one. Five degenerative TFCC injury cases and three positive ulnar variance cases were treated with ulnar shortening. For associated injuries, fixation of the ulnar styloid fragment was selected in one wrist, while in other two wrists, removal of the fragment was performed. Tendon sheath floor of the ECU was repaired, and tenodesis of the ECU tendon was selected in complete ruptured case. Clinical outcome obtained was 12 excellent and 1 good, all returned to original sports level.
This is a preview of subscription content, log in to check access.
Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist - anatomy and function. J Hand Surg. 1981;6:153–62.CrossRefGoogle Scholar
Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg Br. 1996;21:581–6.CrossRefGoogle Scholar
Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin. 2011;27:281–90.CrossRefGoogle Scholar
Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14:594–606.CrossRefGoogle Scholar
Atzei A. Arthroscopic management of DRUJ instability following TFCC ulnar tears. In: del Pinal F, Mathoulin C, Luchetti R, editors. Arthroscopic management of distal radius fractures. Berlin: Springer; 2010. p. 73–88.CrossRefGoogle Scholar
Tay SC, Tomita K, Berger RA. The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am. 2007;32:438–44.CrossRefGoogle Scholar
Moriya T, Aoki M, Iba K, et al. Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur. 2009;34:219–23.CrossRefGoogle Scholar
Nakamura T, Yabe Y, Horiuchi Y. Fat-suppression magnetic resonance imaging of the triangular fibrocartilage complex – comparison with spin echo, gradient echo pulse sequence and histology. J Hand Surg Br. 1999;24:22–6.CrossRefGoogle Scholar
Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop. 1984;187:26–35.Google Scholar
Nishiwaki M, Nakamura T, Nakao Y, et al. Ulnar shortening effect on the distal radioulnar stability: a biomechanical study. J Hand Surg Am. 2005;30:719–26.CrossRefGoogle Scholar
Nishiwaki M, Nakamura T, Nagura T, et al. Ulnar shortening effect on the distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am. 2007;33:198–205.CrossRefGoogle Scholar
Trumble TE, Vedder N. Isolated tears of the triangular fibrocartilage: management by early arthroscopic repair. J Hand Surg Am. 1997;22:57–65.CrossRefGoogle Scholar
Haugstvedt JR, Husby T. Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg Hand Surg. 1999;33:439–47.CrossRefGoogle Scholar
del Pinal F, Garcia-Bernal FJ, Cagigal L, Studer A, Regalado J, Thams C. A technique for arthroscopic all-inside suturing in the wrist. J Hand Surg Eur. 2010;35:475–9.CrossRefGoogle Scholar
Atzei A, Rizzo A, Luchetti R, et al. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Upper Extrem Surg. 2008;12:226–35.CrossRefGoogle Scholar
Iwasaki N, Minami A. Arthroscopically assisted reattachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head. J Hand Surg Am. 2009;34:1323–6.CrossRefGoogle Scholar
Nakamura T, Nakao Y, Ikegami H, Takayama S, Toyama Y. Open repair of the ulnar disruption of the triangular fibrocartilage complex with double 3D-mattress suturing technique. Tech Upper Extrem Surg. 2004;8:116–23.CrossRefGoogle Scholar
Nakamura T. Anatomical reattachment of the TFCC to the ulnar fovea using an ECU half-slip. J Wrist Surg. 2015;4:15–21.CrossRefGoogle Scholar
Nakamura T, Obara Y. The clinical outcome of anatomical re-attachment of the TFCC to the ulnar fovea using an ECU half-slip and interference screw. Handchir Mikrochir Plast Chir. 2015;47:290–6.CrossRefGoogle Scholar
Nakamura T, Abe K, Nishiwaki M, Iwamoto T, Sato K. Medium- to long-term outcomes of anatomical reconstruction of the radioulnar ligament to the ulnar fovea. J Hand Surg Eur Vol. 2017;42(4):352–6.CrossRefGoogle Scholar
Nakamura T, Makita A. The proximal ligamentous component of the triangular fibrocartilage complex: functional anatomy and three-dimensional changes in length of the radioulnar ligament during pronation-supination. J Hand Surg Br. 2000;25:479–86.PubMedGoogle Scholar
Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am. 2002;27:243–51.CrossRefGoogle Scholar