J Wrist Surg 2018; 07(05): 375-381
DOI: 10.1055/s-0038-1661361
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

Taiichi Matsumoto
1   Department of Orthopaedic Surgery, Kurashiki Central Hospital, Okayama, Japan
Peter Tang
2   Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania
Keiji Fujio
3   Department of Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka, Japan
Robert J. Strauch
4   Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
Melvin P. Rosenwasser
4   Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
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23. Dezember 2016

21. Mai 2018

26. Juni 2018 (online)


Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant.

Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair.

Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea.

Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups.

Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.


This study was done at the Anne Youle Stein Center for Orthopedic Education and Research in Columbia University Medical Center, New York, NY.