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Arthroscopic Foveal Repair of Triangular Fibrocartilage Complex Peripheral Lesion With Distal Radioulnar Joint Instability

Atzei, Andrea MD1; Rizzo, Alessandra MD1; Luchetti, Riccardo MD2; Fairplay, Tracy RPT3

Techniques in Hand & Upper Extremity Surgery: December 2008 - Volume 12 - Issue 4 - p 226-235
doi: 10.1097/BTH.0b013e3181901b1
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There is still controversy regarding the value of arthroscopic suture of triangular fibrocartilage complex (TFCC) peripheral tears compared with open transosseous repair because only the latter method restores foveal insertions of TFCC in case of distal radioulnar joint (DRUJ) instability. Five classes of TFCC peripheral tears are recognized in a treatment-oriented algorithm based on arthroscopic findings, and indications to proper treatment are set accordingly. Complete repairable tears (class 2) and proximal repairable tears (class 3) are associated with DRUJ instability and require foveal reattachment of the TFCC. We describe a new arthroscopic technique to repair the foveal attachment of the TFCC with the use of a suture anchor, which is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. This technique requires a dedicated working portal to approach the fovea ulnaris. This Direct Foveal portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and potentially accelerated rehabilitation compared with open repair.

1Hand Surgery Unit, Policlinico "G.B. Rossi", Verona, Italy

2Rimini Hand and Upper Extremity Center, Rimini, Italy

3Private Practice, Bologna, Italy

Address correspondence and reprint requests to Andrea Atzei, MD, Hand Surgery Unit, Policlinico "G.B. Rossi," Verona, Italy. E-mail: andreatzei@libero.it.

© 2008 Lippincott Williams & Wilkins, Inc.