Symptomatic Radial-Sided Tears of the Triangular Fibrocartilage Complex: An All-Arthroscopic Repair Using Bone Anchors

Abstract

Radial-sided tears of the triangular fibrocartilage, though uncommon, can still be a reason for ulnar-sided wrist pain, and, at times, instability of the distal radioulnar joint. Historically, it has been believed that because of the paucity of vascularity along the radial edge of the triangular fibrocartilage complex (TFCC), any form of repair will not lead to healing, thus stating it to be an exercise in futility. Current literature deftly argues against this previously prevailing concept and supports the need of repair in case of symptomatic radial-sided TFCC tears. In our study, we describe an all-arthroscopic technique of repairing radial-sided tears using a bone anchor which can be a fast and simple procedure in the hands of an orthopaedic or hand surgeon trained in arthroscopy. This technique also circumvents the risk of injuring the superficial radial nerve and other radial-sided structures which are stated complications of the current arthroscopic repairs.

An All-arthroscopic Technique of Repair of Substance Tears of the Triangular Fibrocartilage Complex in Symptomatic Patients

“…Whereas, repair techniques and papers on the repair of symptomatic radialsided tears (Palmer 1D), which were historically stated to be irreparable due to the presence of poor vascularity, are emerging in the last few decades with the advent of new data supporting healing after repair in such poorly vascularized regions. 24 Another set of tears, which lie in the poorly vascularized regions are the central perforations and substance tears in the radial side of the TFCC. Minami et al 25 and Osterman 26 both reported good outcomes after debridement of such lesions in patients presenting with pain and no instability.…”

“…There is an abundance of literature on open and arthroscopic repair techniques for ulnar and peripheral triangular fibrocartilage tears, the basis of the inclination to repair is a good healing potential secondary to good vascularity. Whereas, repair techniques and papers on the repair of symptomatic radial-sided tears (Palmer 1D), which were historically stated to be irreparable due to the presence of poor vascularity, are emerging in the last few decades with the advent of new data supporting healing after repair in such poorly vascularized regions 24 . Another set of tears, which lie in the poorly vascularized regions are the central perforations and substance tears in the radial side of the TFCC.…”