Over-the-Top Foveal Triangular Fibrocartilage Complex Repairs With Distal Radioulnar Joint Instability: A...

Area of Science:

• Orthopedic Surgery
• Biomechanics
• Hand and Wrist Anatomy

Background:

• The triangular fibrocartilage complex (TFCC) is crucial for distal radioulnar joint (DRUJ) stability.
• TFCC foveal insertion injuries can lead to ulnar-sided wrist pain and DRUJ instability.

Purpose of the Study:

• To evaluate the effectiveness of an arthroscopic "over-the-top" technique for repairing TFCC foveal avulsions.
• To quantify the improvement in DRUJ stability after TFCC foveal repair using volar-dorsal translation measurements.

Main Methods:

• Utilized eight fresh-frozen cadaveric wrists for biomechanical testing.
• Assessed DRUJ stability in neutral, pronation, and supination after simulated TFCC foveal injury and subsequent arthroscopic repair with varying suture configurations.
• Measured volar-dorsal translation of the distal ulna relative to the radius under applied force.

Main Results:

• TFCC foveal injury significantly increased DRUJ translation in all tested wrist positions.
• Arthroscopic TFCC repair improved DRUJ translation compared to the injured state.
• A three-suture repair configuration yielded the greatest improvement in DRUJ stability.

Conclusions:

• The arthroscopic "over-the-top" TFCC foveal repair technique can effectively restore DRUJ stability.
• Optimal surgical outcomes for foveal TFCC injuries may involve utilizing a three-suture configuration for maximal stability restoration.