All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty for Chronic DRUJ Instability

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Hand and Wrist Surgery

Background:

• Peripheral injuries to the triangular fibrocartilage complex (TFCC) commonly cause distal radioulnar joint (DRUJ) pain and instability.
• Treatment options for TFCC injuries vary based on injury characteristics, tissue viability, and healing potential, as per the Atzei classification.
• For irreparable chronic TFCC injuries without chondral damage or failed prior repairs, ligament reconstruction using tendon grafts (open or arthroscopic) is the preferred treatment.

Purpose of the Study:

• To present a novel, completely arthroscopic technique for TFCC reconstruction utilizing tendon grafts.
• To enhance distal radioulnar joint (DRUJ) stability through this minimally invasive approach.

Main Methods:

• A completely arthroscopic technique for TFCC reconstruction was developed and employed.
• Tendon grafts were utilized to reconstruct the TFCC, anchored in bone tunnels mimicking the native TFCC's anatomic insertions.
• The procedure focused on restoring the TFCC's attachments to the fovea and the sigmoid notch corners.

Main Results:

• The arthroscopic reconstruction technique provides a stable repair of the TFCC following tendon graft integration into bone tunnels.
• This method leverages the anatomical insertion points of the TFCC for optimal stability.
• Arthroscopic approach offers benefits including reduced recovery time, improved aesthetic outcomes, and minimized loss of mobility and pain.

Conclusions:

• Arthroscopic TFCC reconstruction with tendon grafts is an effective method for restoring DRUJ stability in cases of irreparable chronic injuries.
• The technique respects the native TFCC anatomy, promoting robust healing and functional recovery.
• This minimally invasive approach provides significant advantages over traditional open surgeries, enhancing patient recovery and satisfaction.