TFCC Foveal Reconstruction for Chronic DRUJ Instability Using a Single Limb Tendon Graft Technique: A Minimum...

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.

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.

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).

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 IV, Therapeutic.