The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study
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.
Keywordstriangular fibrocartilage complex - foveal - transosseous repair - cadaveric - optimal 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.
- 1 Haugstvedt JR, Husby T. Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (04) 439-447
- 2 Millants P, De Smet L, Van Ransbeeck H. Outcome study of arthroscopic suturing of ulnar avulsions of the triangular fibrocartilage complex of the wrist. Chir Main 2002; 21 (05) 298-300
- 3 Yao J. All-arthroscopic triangular fibrocartilage complex repair: safety and biomechanical comparison with a traditional outside-in technique in cadavers. J Hand Surg Am 2009; 34 (04) 671-676
- 4 Moritomo H. 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 (04) 176-181
- 5 Tang C, Fung B, Chan R, Fok M. The beauty of stability: distal radioulnar joint stability in arthroscopic triangular fibrocartilage complex repair. Hand Surg 2013; 18 (01) 21-26
- 6 Shinohara T, Tatebe M, Okui N, Yamamoto M, Kurimoto S, Hirata H. Arthroscopically assisted repair of triangular fibrocartilage complex foveal tears. J Hand Surg Am 2013; 38 (02) 271-277
- 7 Hermansdorfer JD, Kleinman WB. Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 1991; 16 (02) 340-346
- 8 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
- 9 Iwasaki N, Minami A. Arthroscopically assisted reattachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head. J Hand Surg Am 2009; 34 (07) 1323-1326
- 10 Hoogland T, Hillen B. Intra-articular reconstruction of the anterior cruciate ligament. An experimental study of length changes in different ligament reconstructions. Clin Orthop Relat Res 1984; (185) 197-202
- 11 Penner DA, Daniel DM, Wood P, Mishra D. An in vitro study of anterior cruciate ligament graft placement and isometry. Am J Sports Med 1988; 16 (03) 238-243
- 12 Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN. 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 (03) 445-451
- 13 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (05) 582-591
- 14 Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008; 12 (04) 226-235