J Korean Soc Surg Hand.  2014 Jun;19(2):95-102. 10.12790/jkssh.2014.19.2.95.

Surgical Techniques for Repairing Foveal Tear of the Triangular Fibrocartilage Complex: Arthroscopic Transosseous Repair

• Park JW

• KMID: 2097615
• DOI: http://doi.org/10.12790/jkssh.2014.19.2.95

Abstract

As the importance of the foveal attachment of the triangular fibrocartilage complex (TFCC) on the stability of the distal radioulnar joint (DRUJ) is emphasized, the traditional repair techniques such as arthroscopic capsular repair for the 1B TFCC tear become accepted as ineffective method for treating DRUJ instability. Recently, several techniques which repair the TFCC directly to the ulnar fovea have been developed and introduced. Further advances of the techniques will be expected with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Regardless of the techniques, fundamental principle of anatomical repair of the TFCC to the ulnar fovea is utmost important. Herein we present our technique of arthroscopic transosseous repair by making a drill hole in the ulnar and securing the sutures with Pushlock anchors.

Keyword

Triangular fibrocartilage complex; Arthroscopic transosseous repair

MeSH Terms

Joints
Sutures
Triangular Fibrocartilage*

Figure

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  Fig. 1. Positive hook test indicates 1B pc-TFCC foveal attach tear. TFCC, triangular fibrocartilage complex.

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  Fig. 2. TFCC guide is helpful to make a transosseous tunnel at isometric poistion. TFCC, triangular fibrocartilage complex.

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  Fig. 3. 2.7 mm cannulated drilling for initial drilling. A TFCC guide is helpful to make transosseous tunnel at accurate position. TFCC, triangular fibrocartilage complex.

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  Fig. 4. 4 mm drilling provides more space for stable fixation.

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  Fig. 5. A bent fiberwire at needle tip prevents pull-out of suture from the joint when the needle is pulled-back from the bone tunnel.

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  Fig. 6. (A, B) Fiberwire suture is pulled-out through the 8-R portal.

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  Fig. 7. A nitinol looped wire is passed through the 18-gauge needle.

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  Fig. 8. The fiber wire is passed through the looped wire and pulled-back through the bone tunnel.

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  Fig. 9. (A, B) FIberwire is securely fixed with Pushlock.

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  Fig. 10. Additional suture with cross configuration adds stability.

Reference

References

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