Abstract
Background Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential
for distal radioulnar joint stability. Controversy still exists as to which is the
best treatment in case of foveal lesions. Actual arthroscopic techniques either require
mini open steps or are complex and expensive. We present a simple all inside knotless
repair, providing a strong bony fixation in the fovea.
Materials and Methods Through 3–4 and 6R portals, the ulnar fovea is debrided and a wire is passed percutaneously
through the TFCC to place a mattress suture at its free end. It is then reattached
to the fovea with an impacted anchor.
Retrospective Study Between 2013 and 2016, a cohort of 5 patients presenting with isolated Palmer 1B,
EWAS 2 lesions of the TFCC were operated on with this technique. Clinical evaluation
was based on a compared measurement of the grip strength, pain on a visual analogic
scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability.
We also used functional scores: Mayo modified wrist score (MMWS), Quick disability
arm, shoulder and hand (DASH), and patient-related wrist evaluation (PRWE). The average
follow-up was 29.4 months (range 9–42 months).
Results On postoperative evaluation, pain was reduced by 5 points (range 1–9) and grip strength
averaged 94% of the unaffected side. Range of motion averaged 92% on the unaffected
side. DRUJ instability was slight in 4 patients and mild in 1 patient. MMWS was excellent
for 1, good for 1, and satisfactory for 3 patients. Quick Dash averaged 17.68 (range
0–38.6) compared with preoperative average of 59.48 (range 45–77) with an amelioration
of 43 (range 34–57).
PRWE averaged 20 (range 1–41.5) compared with preoperative average of 60.3 (range
33.5–76.5) with an amelioration of 41 (range 32–58). We reported no complications
and particularly no lesions of the dorsal sensory branch of the ulnar nerve.
Conclusions We present a simple arthroscopic technique using a single suture anchor placed in
the ulnar fovea. Repairs performed with this technique are simple and the results
achieved seem to be similar to those obtained with conventional open or arthroscopic
techniques, although further investigation with an increased number of patients and
follow-up are required. It however became our first choice of treatment in European
Wrist Arthroscopy Society (EWAS) 2 lesions of the TFCC.
Keywords
wrist arthroscopy - TFCC - foveal
