Anatomy of TFC Reconstruction with Tendon Graft

Introduction Chronic instability of the distal radio ulnar joint is a common cause of arthritis of this joint, leading to pain and loss of function of the forearm.

In cases of ulna plus or ulna neutral variance, 2.5 mm ulnar shortening can restore stability in those patients with minor instability. When the patient has ulna minus variance or when there is major instability, ligament reconstruction is the only possibility.

Early diagnosis and treatment will prevent development of post-traumatic arthritis of the distal radio ulnar joint in the majority of cases treated, on whom the ligaments of the triangular fibro cartilage are repaired or reconstructed to the length and position of the original ligaments.

Many techniques for reconstruction of the ligaments of the triangular fibro cartilage have been described, most are extra anatomical and the majority fail to stabilize the joint to its original status.

Materials and Methods We present a reconstructive technique, utilizing a tendon graft that follows the normal path of the triangular fibro cartilage ligaments, reducing the gap of the ruptured ligament/s and adding collagen to strengthen the repair. This technique has passed the test of time and has been in use for over 20 years.

The details of the reconstructive procedures are presented for the dorsal, the palmar and for both ligaments together when needed, rather than utilizing the same approach for all the instabilities.

Conclusion We have found that when the reconstruction of the triangular fibro cartilage ligaments has been performed within 6 months of the injury, the results have been long lasting, while those cases that have had delayed repair have continued to develop arthritic changes even though the joint is stable.