Reconstruction of the Radioulnar Ligament

The word “TFCC” or “triangular fibrocartilage complex” was firstly used in Palmer and Werner's paper in 1981.[1] This historical paper indicates detailed anatomy of the TFCC and, to me, the most important message of this paper is to consider the TFCC as a complex of the triangular fibrocartilage with surrounding ligaments, because those tissues could not be separated. Each ligament of the TFCC is not isolated, separated, and independent. The connecting area between the ligaments and fibrocartilage are mixture of the fibers. In 1996, Nakamura et al described three-dimensional (3D) anatomy of the TFCC and detailed attaching area of the TFCC to the ulnar fovea and to the radial sigmoid notch.[2] The radioulnar ligament (RUL) is one of the components of the TFCC and the primary stabilizer of the distal radioulnar joint (DRUJ); however, the RUL cannot be separated from the TFCC. The RUL locates the proximal surface of the TFCC 3D.[3]

Reconstruction techniques of the RUL have been found from 1930's with simple or complex tenodesis wrapping around technique on the radius and ulna[4] or ulnocarpal tenodesis.[5] However, these techniques were in failure. In 2022, Adams and Berger described RUL reconstruction technique using the palmaris longus tendon.[6] Nakamura et al described the more 3D reconstruction of the RUL using the remnant of the detached TFCC and the ECU-half-slip.[7] The latter two techniques were reported with adequate clinical results.

“The Editor's pick” of this issue is “The comparison between direct graft fixation using a biotenodesis screw combined with early mobilization versus a traditional knot fixation with 6-week immobilization of Adams–Berger TFCC reconstruction” described by Drs. Scholtmeijer, van den Berg, and Kemler. This paper described modification of the Adams–Berger technique using biotenodesis screw for earlier mobilization and outcomes of modified TFCC reconstruction technique were compared with the traditional knot technique with a 6-week cast immobilization. The authors concludes that earlier immobilization with strong tethering technique using interference screw obtained better clinical outcomes.

Interesting wrist papers, such as the TFCC, scapholunate injury, distal radius fracture, ulnar shortening, thumb carpometacarpal joint disease, scaphoid proximal pole nonunion, DRUJ morphology, systematic review of resurfacing capitate pyrocarbon implants, procedures, and interesting case report, are included in this issue. Don't miss them.

Publikationsverlauf

Eingereicht: 05. August 2025

Angenommen: 05. August 2025

Artikel online veröffentlicht:
23. September 2025

• References

• 1 Palmer AK, Werner FW. The triangular fibrocartilage complex of the wrist–anatomy and function. J Hand Surg Am 1981; 6 (02) 153-162
• 2 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (05) 581-586
• 3 Nakamura T, Makita A. The proximal ligamentous component of the triangular fibrocartilage complex. J Hand Surg [Br] 2000; 25 (05) 479-486
• 4 Teoh LC, Yam AKT. Anatomic reconstruction of the distal radioulnar ligaments: long-term results. J Hand Surg [Br] 2005; 30 (02) 185-193
• 5 Hui FC, Linscheid RL. Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 1982; 7 (03) 230-236
• 6 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
• 7 Nakamura T, Obara Y. The clinical outcome of anatomical re-attachment of the TFCC to the ulnar fovea using an ECU half-slip and interference screw. Handchir Mikrochir Plast Chir 2015; 47 (05) 290-296