Purpose
Arthroscopic repair is performed for fovea injuries of the triangular fibrocartilage
complex (TFCC) when instability of the distal radioulnar joint results in pain, decreased
grip strength, and mechanical symptoms. During TFCC repair, reconstruction of its
attachment to the fovea is important. Nonabsorbent suture tapes have gained attention
for ligament repair in the trapeziometacarpal joint, scapholunate ligament, and thumb
metacarpophalangeal ligament. However, there are no reports of TFCC repair using suture
tapes. We evaluated the early postoperative results of this approach.
Methods
Participants underwent arthroscopic suture tape repair of foveal TFCC tears and were
observed for more than 1 year. All repairs were performed using suture tapes and an
outside-in technique with a bone tunnel from the ulnar shaft to the fovea. The postoperative
complications, postoperative wrist range of motion, grip strength, and the Modified
Mayo Score were evaluated.
Results
Arthroscopic repair with a suture tape was performed for 20 hands using the outside-in
technique. The ranges of motion for the operated and nonoperated hands were comparable
1 year after surgery (pronation, 84° ± 4°; supination, 83° ± 4°). The mean grip strength
improved from 65% ± 13% before surgery to 89% ± 9% after a year. The mean Modified
Mayo Score improved from 58 ± 11 before surgery to 91 ± 8 after a year. Postoperative
complications included abnormal sensation of the dorsal ulnar side in 2 hands.
Conclusions
After using a suture tape to attach the TFCC to the fovea, satisfactory function was
achieved in the early postoperative period with grip strength restoration. For the
repair of foveal TFCC tears, attachment to the ulnar fovea is important, and repair
by a suture tape may be useful.
Type of study/level of evidence
Therapeutic IV.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- New advances in wrist arthroscopy.Arthroscopy. 2008; 24: 355-367
- The triangular fibrocartilage complex of the wrist—anatomy and function.J Hand Surg Am. 1981; 6: 153-162
- Anatomic foveal reconstruction of the triangular fibrocartilage complex with a tendon graft.Tech Hand Up Extrem Surg. 2014; 18: 92-97
- Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint.J Hand Surg Am. 2006; 31: 445-451
- Origins and insertions of the triangular fibrocartilage complex: a histological study.J Hand Surg Br. 2001; 26: 446-454
- Foveal TFCC tear classification and treatment.Hand Clin. 2011; 27: 263-272
- Chronologic and geographic trends of triangular fibrocartilage complex repair.Hand Clin. 2017; 33: 593-605
- Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques.Hand Clin. 2011; 27: 281-290
- Advantages of open repair of a foveal tear of the triangular fibrocartilage complex via a palmar surgical approach.Tech Hand Up Extrem Surg. 2009; 13: 176-181
- Suture tape augmentation for scapholunate ligament repair: a biomechanical study.J Hand Surg Am. 2021; 46: 36-42
- Internal bracing augmentation for scapholunate interosseous ligament repair: a cadaveric biomechanical study.J Hand Surg Am. 2020; 45: 985.e1-985.e9
- Kinematics of thumb ulnar collateral ligament repair with suture tape augmentation.J Hand Surg Am. 2020; 45: 117-122
- Assessing new technologies in surgery: case example of acute primary repair of the thumb ulnar collateral ligament.J Hand Surg Am. 2021; 46: 666-674.e5
- Suture tape augmentation of the thumb ulnar collateral ligament repair: a biomechanical study.J Hand Surg Am. 2018; 43: 868.e1-868.e6
- A biomechanical comparison of the pullout strength of no. 2 FiberWire suture and 2-mm FiberWire tape in bovine rotator cuff tendons.Arthroscopy. 2010; 26: 1463-1468
- Management of chronic peripheral tears of the triangular fibrocartilage complex.J Hand Surg Am. 1991; 16: 340-346
- An evaluation of the reliability of wrist arthroscopy in the assessment of tears of the triangular fibrocartilage complex.J Hand Surg Am. 2018; 43: 545-549
- The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity.J Hand Surg Am. 2007; 32: 438-444
- Open repair of the triangular fibrocartilage complex from palmar aspect.J Wrist Surg. 2015; 4: 2-8
- Hand strength: normative values.J Hand Surg Am. 1994; 19: 665-670
- Hand-grip strength: normative reference values and equations for individuals 18 to 85 years of age residing in the United States.J Orthop Sports Phys Ther. 2018; 48: 685-693
- Difficult wrist fractures. Perilunate fracture-dislocations of the wrist.Clin Orthop Relat Res. 1987; 214: 136-147
- Arthroscopic management of triangular fibrocartilage complex foveal injury.Hand Clin. 2017; 33: 619-624
- Distal ulnar metaphyseal wedge osteotomy for ulnar abutment syndrome.J Wrist Surg. 2019; 8: 352-359
- The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex.Curr Probl Diagn Radiol. 2016; 45: 39-50
- Instability of the distal radioulnar joint–an overview of clinical and radiological procedures regarding their efficacies. Article in German.Handchir Mikrochir Plast Chir. 2014; 46: 137-150
- Suture tape augmentation improves laxity of MCL repair in the ACL reconstructed knee.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 2545-2552
- The failure mode of two reabsorbable fixation systems: Swivelock with Fibertape versus Bio-Corkscrew with Fiberwire in bovine rotator cuff.J Orthop Sci. 2012; 17: 789-795
- Functional outcomes are similar after early and late arthroscopic one-tunnel transosseous repair of triangular fibrocartilage complex foveal tears.Arthroscopy. 2020; 36: 1845-1852
- Midterm results after open versus arthroscopic transosseous repair for foveal tears of the triangular fibrocartilage complex.J Wrist Surg. 2018; 7: 292-297
- Arthroscopic trans-osseous suture of peripheral triangular fibrocartilage complex tear.J Hand Surg Asian Pac vol. 2016; 21: 300-306
- Arthroscopic one-tunnel transosseous foveal repair for triangular fibrocartilage complex (TFCC) peripheral tear.Arch Orthop Trauma Surg. 2018; 138: 131-138
Article info
Publication history
Published online: February 23, 2023
Accepted:
September 15,
2022
Received:
February 12,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.