Technique of arthroscopic-assisted foveal repair for TFCC 1B lesion
Epublication WebSurg.com, Apr 2012;12(04). URL: http://websurg.com/doi/vd01en3658
Three classes of TFCC peripheral 1B tears are recognized in a treatment-orientated algorithm based on arthroscopic findings. Distal tear (class 1), associated with minimal instability of the DRUJ, requires ligament to capsule suture. Complete (class 2) and proximal tears (class 3) are associated with major DRUJ instability and require foveal re-attachment of the TFCC. A new arthroscopic-assisted technique to repair the foveal attachment of the TFCC by using a suture anchor is described. It is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. The technique requires a dedicated working portal called Direct Foveal (DF) to approach the ulnar fovea. This DF portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher or a simple mosquito forceps. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and easier rehabilitation as compared to open repair.