Arch Hand Microsurg.  2020 Sep;25(3):167-174. 10.12790/ahm.20.0026.

Arthroscopic Repair of Triangular Fibrocartilage Complex Tear

• Seo H
• Lee JY

• KMID: 2505897
• DOI: http://doi.org/10.12790/ahm.20.0026

Abstract

Triangular fibrocartilage complex (TFCC) is an important structure for stability of distal radioulnar joint (DRUJ) and shock absorption of ulnocarpal joint. Recent studies on anatomy and biomechanics of TFCC have revealed that the deep fiber of distal radioulnar ligament plays a key role in stabilizing the DRUJ. Clinicians should evaluate the presence of the instability of DRUJ or ulnar impaction syndrome. If necessary, combined TFCC foveal repair and ulnar shortening osteotomy should be performed. This article introduces the authors’ preferred procedure of arthroscopic TFCC repair with satisfactory clinical outcomes.

Keyword

Wrist; Triangular fibrocartilage; Arthroscopy

Figure

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  Fig. 1. Cross section of the triangular fibrocartilage complex. DRUL, distal radioulnar ligament.

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  Fig. 2. A 25-year-old male patient sustained left ulnar-sided wrist pain. (A, B) Dorsal subluxation of ulnar head was found in transverse magnetic resonance imaging (MRI) images in T1 and T2. (C) Coronal MRI image showed focal increased signal change in deep fiber of dorsal radioulnar ligament around ulnar fovea. (D) The ulnar head showed dorsal subluxation in sagittal MRI image.

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  Fig. 3. Trampoline test is an arthroscopic evaluation of tension of triangular fibrocartilage complex.

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  Fig. 4. The wrist hangs on the traction device with forearm semisupination.

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  Fig. 5. Schematic drawing shows that 20-gauge needle containing 2-0 Prolene (Ethicon, Somerville, NJ, USA) penetrates the triangular fibrocartilage complex.

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  Fig. 6. Arthroscopic images of 30-year-old male patient. (A) With the aid of 20-gauge needle, 2-0 Prolene (Ethicon, Somerville, NJ, USA) passed through the volar part of triangular fibrocartilage complex (TFCC). After taking the intraarticular end of 2-0 Prolene out of the joint, Fiberwire (Arthrex, Naples, FL, USA) and 2-0 Prolene were tied up. (B) Prolene (2-0) substituted for Fiberwire by drawing the untied end of 2-0 Prolene. (C-H) In the same manner, two more stitches on dorsal part and midpoint of TFCC were done to make the Mason-Allen stitch.

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  Fig. 7. Suture anchor is placed via 6 ulnar portal. Dorsal branch of ulnar nerve should be protected during the procedure.

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  Fig. 8. Postoperative image of computed tomography shows that the anchor (arrow) was inserted in central area of ulnar fovea via 6 ulnar portal (arrowhead).

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