Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

Abstract

Background Foveal disruption of the triangular fibrocartilage complex (TFCC) is associated with distal radioulnar joint (DRUJ) instability. TFCC fixation onto the fovea is the suitable treatment, which is not achieved by conventional arthroscopic techniques. We describe an all-inside arthroscopic technique that uses a suture anchor through distal DRUJ arthroscopy for foveal repair of the TFCC. Materials and Methods Forty-eight patients with TFCC foveal tear and DRUJ instability were selected according to the Atzei-European Wrist Arthroscopy Society (EWAS) algorithm of treatment. Retrospective evaluation included pain, DRUJ instability, range of motion (ROM), grip strength, Modified Mayo Wrist Score (MMWS), and the Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Description of Technique DRUJ arthroscopy was performed to débride the TFCC and the foveal area. Under arthroscopic guidance, a suture anchor was inserted via the distal foveal portal to repair the TFCC onto the fovea. Sutures were tied on the radiocarpal surface of the TFCC. Postoperative immobilization of forearm rotation was maintained for 4 weeks. Heavy tasks were allowed after 3 months. Results After a mean follow-up of 33 months, pain improved significantly but remained moderate in four patients, severe in one. DRUJ instability resolved in 44 patients. Wrist ROM increased. Grip strength, MMWS, and DASH score improved significantly. Excellent and good MMWS equaled 83.3%. Forty-one patients (85.5%) resumed previous work and sport activities. As a postoperative complication, five patients experienced neuroapraxia of the dorsal sensory branch of the ulnar nerve (DSBUN) with full spontaneous recovery. Conclusions With appropriate indications and patient selection, arthroscopic foveal repair of the TFCC may restore DRUJ stability and provide satisfactory results without significant complications.

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear

“…1 In addition to wrist pain, TFCC injuries result in decreased grip strength and impaired hand function. 2 TFCC injuries are managed non-operatively initially. Immobilization, activity modification, and analgesics are used for a few weeks.…”

Arthroscopic reduction of an irreducible distal radioulnar joint in Galeazzi fracture-dislocation due to a fragment of the ulnar styloid: a case report

“…DRUJ arthroscopy is being adopted because of the recent developments in medical technology and improvement in surgical techniques. This technique has been recently used for arthroscopic repair for TFCC injury, resection of the ulnar head for ulnar abutment syndrome, and the arthroscopic Sauve-Kapandji procedure [13, 14]. When the incision for the dorsal capsule and ECU subsheath, which comprise the TFCC, was performed for open reduction, postoperative immobilization was necessary for several weeks.…”

Arthroscopic resection of an osteochondral loose body in the distal radioulnar joint: A case report

“…DRUJ arthroscopy is now used for arthroscopic repair of TFCC and arthroscopic resection of ulnar head for ulnar abutment syndrome. 13 , 14 Arthroscopic resection for loose body in DRUJ is, therefore, a potential treatment.…”