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.
Keywords
triangular fibrocartilage complex - TFCC - foveal repair - arthroscopy - DRUJ instability
