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J Wrist Surg
DOI: 10.1055/a-2640-4354
Scientific Article

TFCC Foveal Reconstruction for Chronic DRUJ Instability Using a Single Limb Tendon Graft Technique: A Minimum 32-month Follow-up Study

Bo Liu 
1   Department of Hand Surgery, Capital Medical University and Fourth Clinical College of Peking University, Beijing Jishuitan Hospital, Beijing, China
2   Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
,
Rebecca Qian Ru Lim 
3   Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, Singapore
› Author Affiliations
Funding The author(s) disclose receipt of the following financial or material support for the research, authorship, and/or publication of this article: 1. National Natural Science Foundation of China (code: 82272581). 2. Yunnan Provincial Science and Technology Department (code: 202105AF150050).
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Abstract

Purpose

In patients with symptomatic chronic distal radio-ulnar joint (DRUJ) instability with irreparable triangular fibrocartilage complex (TFCC), reconstruction with a tendon graft is indicated. We performed a follow-up study with a minimum 32-month follow-up in a bid to propose an arthroscopic TFCC anatomical reconstruction technique using a single limb of tendon graft as a viable option for patients with irreparable TFCC and chronic symptomatic DRUJ instability.

Materials and Methods

Between 2015 and 2021, eight (four females, four males) patients with an average age of 29.5 years underwent this novel technique. Standard wrist arthroscopy portals were used. The palmaris longus was harvested with one end fashioned into an oblong-shaped tendon ball and secured with sutures. A bone tunnel was created at the metaphyseal region of the distal ulnar in the direction of the center of the fovea. The free end of the tendon graft was fed through the 6R portal and pulled via this bone tunnel to restore the foveal footprint. The wrist range of motion (ROM), grip strength, Patient-Rated Wrist Evaluation (PRWE), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), and Mayo Wrist Score (MWS) were used for evaluation pre-surgery and at follow-up.

Results

At a minimum follow-up of 32 months (mean 77.5 months, range 32–105 months), DRUJ was stable in all patients. Comparing pre- and postoperative data, there was improvement with significant p-values in grip strength as compared with contralateral wrist (84 to 107%), PRWE (34.5 to 4.3), Q-DASH (28.2 to 3.4), and MWS (75 to 95). The average duration of the operation was 69.3 minutes (range 52–95 minutes).

Conclusion

TFCC foveal reconstruction using a single limb of tendon graft is a viable arthroscopic technique in patients with symptomatic chronic DRUJ instability and irreparable TFCC.

Level of Evidence

Level IV, Therapeutic.

Keywords

triangular fibrocartilage complex (TFCC) - distal radio-ulnar joint instability (DRUJ instability) - fovea reconstruction - tendon graft - wrist arthroscopy

Authors'Contributions

All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors. B.L.: Conceptualization; B.L. and R.Q.R.L.: Resources; B.L. and R.Q.R.L.: Writing—original draft; B.L. and R.Q.R.L.: Writing—review and editing; B.L. and R.Q.R.L.: Visualization; R.Q.R.L.: Supervision; B.L.: Funding acquisition. All authors had full access to the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.


Ethical Approval

Ethical approval to report these cases was obtained from the Beijing Jishuitan Hospital, Capital Medical University K20242400.




Publication History

Received: 06 September 2024

Accepted: 17 June 2025

Article published online:
08 July 2025

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