Arthroscopic Treatment of Type 1B Triangular Fibrocartilage Complex Tear by “Outside-In” Repair Technique Using Transcapsular Transverse Mattress Suture

Abstract

Triangular fibrocartilage complex (TFCC) injuries are increasingly recognized as a cause of ulnar-sided wrist pain. Palmer grouped these tears into either traumatic or degenerative, with various subclassifications. Magnetic resonance imaging (MRI), arthrogram, and arthroscopy are the methods used to establish the diagnosis. Several arthroscopic methods of TFCC repair including outside-in, inside-out, and all-inside techniques have been described. The outside-in repair, which involves piercing the TFCC via the ulnar side of the wrist, has been described by several authors, but the technique varies among authors with respect to instrumentation and subtle surgical modifications. The purpose of this article was to present the technique of arthroscopic outside-in repair using transverse mattress suture for type 1B TFCC tear by modifying classic vertical mattress sutures into sutures that pass completely through the disc.

Improved Outside-In Suture through the Joint Capsule to Repair the Palmer I-B Triangular Fibrocartilage Complex Superficial Injury

“…Scholars have also made some explorations on stitching methods. Bayoumy et al [ 11 ] proposed that the horizontal mattress suture is more biomechanically stable than the longitudinal mattress suture and can effectively reduce the cutting effect of the suture, but it still cannot avoid the complications of the ulnar nerve and the irritation of the knot on the skin. Scholars continue to report that patients who repaired the Palmer I-B TFCC superficial injury via joint capsule suture under arthroscopy were found to have symptoms of nerve irritation after surgery [ 19 – 20 ].…”

“…However, many scholars have reported that patients treated by outside-in suture method have found that the dorsal branch of the ulnar nerve is injured or the local irritation symptoms are found. This is often caused by the suture knot irritating the dorsal branch of the ulnar nerve or the skin [ 2 , 3 , 11 , 17 ]. Our research group innovatively modified the traditional outside-in suture of the joint capsule and modified the traditional extracapsular suture to intracapsular suture and found that the incidence of postoperative nerve irritation in patients can be significantly reduced.…”

“…For patients with I-B injuries who have failed conservative treatment or have surgical indications, surgery is generally required. According to different types of injury, such as simple superficial ligament injury or combined deep ligament injury, the current surgical methods mainly include transarticular capsule repair, ulnar foveal ligament stop point reconstruction, ligament transplantation reconstruction, and distal radioulnar joint replacement plastic surgery [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. For patients with simple superficial ligament injury, the current mainstream repair method is the outside-in suture through the joint capsule [2,3,11,17].…”

“…According to different types of injury, such as simple superficial ligament injury or combined deep ligament injury, the current surgical methods mainly include transarticular capsule repair, ulnar foveal ligament stop point reconstruction, ligament transplantation reconstruction, and distal radioulnar joint replacement plastic surgery [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. For patients with simple superficial ligament injury, the current mainstream repair method is the outside-in suture through the joint capsule [2,3,11,17]. However, many scholars have reported that patients treated by outside-in suture method have found that the dorsal branch of the ulnar nerve is injured or the local irritation symptoms are found.…”

Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: Clinical and radiographic outcomes at 4 years’ mean follow-up

“…It is used to guide the surgical treatment, whether arthroscopic or open. Satisfactory outcomes have been described after reattaching the peripheral portion of the TFCC using various arthroscopic techniques [7][8][9][10]. Nevertheless, these well-known techniques are not sufficient to restore DRUJ stability when the proximal attachment is avulsed and the joint unstable.…”