Arthroscopic Trans-osseous Suture of Peripheral Triangular Fibrocartilage Complex Tear

Abstract

The importance of foveal repair of the triangular fibrocartilage complex (TFCC) on stability of the distal radioulnar joint (DRUJ) has been emphasized with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Although both open and arthroscopic techniques have been described for improving DRUJ stability, there has been a marked evolution of arthroscopic TFCC repair technique with successful clinical outcome. Recently, an arthroscopic trans-osseous technique has been described to repair foveal tears of the TFCC. The advantage of the technique is that it allows for anatomical repair of both the superficial and deep layers. This article describes the details of this novel technique.

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

“…26,40,48 Fourteen studies reported peripheral TFCC repairs [26][27][28][29][30][31][32][33][34][35][36][37][38][39] and 13 studies reported foveal avulsions of the TFCC. [40][41][42][43][44][45][46][47][48][49][50][51][52] As the pathoanat-omy of these tears and repair techniques differ, the outcomes of peripheral and foveal tears were analyzed separately.…”

“…Seven papers reported a transosseous repair technique. 40,[44][45][46][50][51][52] Iwasaki et al performed arthroscopicassisted transosseous repair using a guiding device through the four to five portal, targeting the fovea. An outside-in technique for the suture shuttle was then utilized, with the sutures finally tied onto the ulnar periosteum over the proximal entrance of the osseous tunnel.…”

“…The sutures entering through these transosseous tunnels would be tied down and fixed by knotting over the joint capsule. 46 Park et al and Jung et al inserted the aiming guide through 6R portal toward the fovea. Under arthroscopic control, they passed the suture which grasped the TFCC through the transosseous tunnel and secured with a suture anchor proximal to the trajectory of the bone tunnel.…”

“…26,29,33,47 Return to heavy activities and sport was at 3 to 6 months after surgery. 28,32,40,41,43,46,48,50 Complications…”

“…Iwasaki et al and Kim et al reported postoperative ECU tendonitis in three patients of their cohorts (11.1%)-all resolved with conservative management or cortisone injection. 45,47 Extensor digiti minimi irritation (2.7%, n ¼ 1) 28 and mild irritation surrounding suture knots (47.4%, n ¼ 9,) 46 were noted, and resolved without surgical intervention. Other complications included chronic regional pain syndrome (8.3%, n ¼ 2) 42 and hypertrophic scarring (2.5%, n ¼ 1).…”