Journal List > J Korean Soc Surg Hand > v.19(2) > 1106485

Park: Surgical Techniques for Repairing Foveal Tear of the Triangular Fibrocartilage Complex: Arthroscopic Transosseous Repair


As the importance of the foveal attachment of the triangular fibrocartilage complex (TFCC) on the stability of the distal radioulnar joint (DRUJ) is emphasized, the traditional repair techniques such as arthroscopic capsular repair for the 1B TFCC tear become accepted as ineffective method for treating DRUJ instability. Recently, several techniques which repair the TFCC directly to the ulnar fovea have been developed and introduced. Further advances of the techniques will be expected with increasing knowledge of the anatomy and biomechanics of the TFCC and DRUJ. Regardless of the techniques, fundamental principle of anatomical repair of the TFCC to the ulnar fovea is utmost important. Herein we present our technique of arthroscopic transosseous repair by making a drill hole in the ulnar and securing the sutures with Pushlock anchors.


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Fig. 1.
Positive hook test indicates 1B pc-TFCC foveal attach tear. TFCC, triangular fibrocartilage complex.
Fig. 2.
TFCC guide is helpful to make a transosseous tunnel at isometric poistion. TFCC, triangular fibrocartilage complex.
Fig. 3.
2.7 mm cannulated drilling for initial drilling. A TFCC guide is helpful to make transosseous tunnel at accurate position. TFCC, triangular fibrocartilage complex.
Fig. 4.
4 mm drilling provides more space for stable fixation.
Fig. 5.
A bent fiberwire at needle tip prevents pull-out of suture from the joint when the needle is pulled-back from the bone tunnel.
Fig. 6.
(A, B) Fiberwire suture is pulled-out through the 8-R portal.
Fig. 7.
A nitinol looped wire is passed through the 18-gauge needle.
Fig. 8.
The fiber wire is passed through the looped wire and pulled-back through the bone tunnel.
Fig. 9.
(A, B) FIberwire is securely fixed with Pushlock.
Fig. 10.
Additional suture with cross configuration adds stability.
Table 1.
Classification of Palmer 1B triangular fibrocartilage complex tear (Modified from Atzei et al.1)
Class DRUJ instability Involved TFCC component TFCC healing potential Status of DRUJ cartilage Treatment
Distal Proximal
Class 1: repairable distal tear None or slight Torn Intact Good Good Repair: suture (lig-to-capsule)
Class 2: reparable complex tear Mild or severe Tom Tom Good Good Repair (foveal refixation)
Class 3: reparable proximal tear Mild or severe Intact Torn Good Good Repair (foveal refixation)
Class 4: non-reparable Severe Tom Tom Poor Good Reconstruction (tendon graft)
Class 5: DRUJ arthritis Mild or severe * * * Poor Salvage (arthroplasty or joint replacement)

Novel classification based on arthroscopic findings provides guidelines for treatment of different TFCC peripheral tears.

TFCC, triangular fibrocartilage complex; DRUJ, distal radioulnar joint.

* Class 5, whose main characteristic consists of DRUJ cartilage degeneration, includes different conditions.

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