Outcomes of an All-Arthroscopic Technique of Anatomical Repair of Complete Foveal Tears of the Triangular Fibrocartilage Complex

Abstract

Background

Foveal tears of the triangular fibrocartilage complex (TFCC) present challenges for hand and wrist surgeons due to their impact on wrist stability and function. This study aims to evaluate the safety and effectiveness of a modified 3-portal all-arthroscopic technique using a bony anchor.

Materials and Methods

A retrospective review of 19 consecutive TFCC tear repairs was conducted. Patients with ulnar-sided wrist pain and confirmed TFCC tears underwent surgery by a single surgeon. Clinical data, surgical techniques, and outcomes were analyzed.

Results

The majority of patients experienced significant improvements in pain, grip strength, and range of motion following surgery. The technique showed improvements in pain relief (74% reported no pain), grip strength restoration (mean restoration of 93%), and range of motion(mean restoration of 97%). Utilizing the modified Mayo wrist score, 12 patients (63%) achieved excellent outcomes, 6 patients (32%) attained good outcomes, and 1 patient (5%) had satisfactory outcomes.

Conclusion

This modified 3-portal arthroscopic TFCC repair technique using a bony anchor technique can effectively alleviate symptoms and improve wrist function in patients with TFCC tears.

Level of Evidence

Level IV

Keywords

triangular fibrocartilage complex - arthroscopic repair - foveal tears - wrist stability - bony anchor

Author's Contributions

Z.C. was responsible for manuscript writing. V.E.L. was responsible for editing and proofreading. M.M.C. was responsible for research conception and proofreading.

Publication History

Received: 09 December 2024

Accepted: 16 June 2025

Article published online:
01 July 2025

• References

• 1 Ahn AK, Chang D, Plate AM. Triangular fibrocartilage complex tears: a review. Bull NYU Hosp Jt Dis 2006; 64 (3-4): 114-118
• 2 Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk Jr GR. The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex. Curr Probl Diagn Radiol 2016; 45 (01) 39-50
• 3 Mikic ZD. Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability. J Hand Surg Am 1995; 20 (02) 319-323
• 4 Casadei K, Kiel J. Triangular Fibrocartilage Complex. StatPearls;; 2024
• 5 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 6 Atzei A, Luchetti R, Garagnani L. Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears. J Hand Surg Eur Vol 2017; 42 (04) 405-414
• 7 Jawed A, Ansari MT, Gupta V. TFCC injuries: how we treat?. J Clin Orthop Trauma 2020; 11 (04) 570-579
• 8 Atzei A, Luchetti R, Braidotti F. Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg 2015; 4 (01) 22-30
• 9 Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open versus arthroscopic repair of 1b ulnar-sided triangular fibrocartilage complex tears: a systematic review. Hand (N Y) 2020; 15 (04) 456-464
• 10 Liu EH, Suen K, Tham SK, Ek ET. Surgical repair of triangular fibrocartilage complex tears: a systematic review. J Wrist Surg 2021; 10 (01) 70-83
• 11 Saito T, Sterbenz JM, Chung KC. Chronologic and geographic trends of triangular fibrocartilage complex repair. Hand Clin 2017; 33 (04) 593-605
• 12 Corso SJ, Savoie FH, Geissler WB, Whipple TL, Jiminez W, Jenkins N. Arthroscopic repair of peripheral avulsions of the triangular fibrocartilage complex of the wrist: a multicenter study. Arthroscopy 1997; 13 (01) 78-84
• 13 Demino C, Morales-Restrepo A, Fowler J. Surgical management of triangular fibrocartilage complex lesions: a review of outcomes. J Hand Surg Glob Online 2019; 1 (01) 32-38
• 14 Choudhury MM, Yap RTJ, Jiang JKH, Chia DSY, Chin AYH. An all-arthroscopic technique of repairing foveal tears of the triangular fibrocartilage complex using a bone anchor-repair made simple. Tech Hand Up Extrem Surg 2024; 28 (01) 19-25
• 15 Slutsky DJ. Outcomes assessment in wrist surgery. J Wrist Surg 2013; 2 (01) 1-4
• 16 Krebs EE, Carey TS, Weinberger M. Accuracy of the pain numeric rating scale as a screening test in primary care. J Gen Intern Med 2007; 22 (10) 1453-1458
• 17 Ecker J, Andrijich C. Dry arthroscopy distal radioulnar joint and foveal insertion: surgical technique. J Wrist Surg 2021; 11 (01) 2-5
• 18 del Piñal F, García-Bernal FJ, Pisani D, Regalado J, Ayala H, Studer A. Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am 2007; 32 (01) 119-123
• 19 Atzei A, Luchetti R, Carletti D, Marcovici LL, Cazzoletti L, Barbon S. The hook test is more accurate than the trampoline test to detect foveal tears of the triangular fibrocartilage complex of the wrist. Arthroscopy 2021; 37 (06) 1800-1807
• 20 Zlatkin MB, Rosner J. MR imaging of ligaments and triangular fibrocartilage complex of the wrist. Radiol Clin North Am 2006; 44 (04) 595-623 , ix
• 21 Haims AH, Schweitzer ME, Morrison WB. et al. Limitations of MR imaging in the diagnosis of peripheral tears of the triangular fibrocartilage of the wrist. AJR Am J Roentgenol 2002; 178 (02) 419-422
• 22 Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H. Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 2011; 27 (03) 281-290
• 23 Kermarrec G, Cohen G, Upex P, Fontes D. Arthroscopic foveal reattachment of the triangular fibro cartilaginous complex. J Wrist Surg 2020; 9 (03) 256-262
• 24 Liu B, Arianni M, Wu F. Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study. J Hand Surg Eur Vol 2021; 46 (03) 270-277