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Optimizing Drill Guide Positioning for Foveal Targeting in Arthroscopic One-Bone Tunnel Triangular Fibrocartilage
Jae Jun Nam1, In Cheul Choi1, Yeongyoon Koh1
1Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
Clinics in Orthopedic Surgery
|August 5, 2026
Summary
This study identifies optimal drill guide placement for triangular fibrocartilage complex (TFCC) tears during arthroscopic repair. A specific landmark on the articular disc aids in precise targeting for improved surgical outcomes.
Area of Science:
- Orthopedic Surgery
- Radiology
- Anatomy
Background:
- Triangular fibrocartilage complex (TFCC) injuries, particularly Palmer type 1B foveal tears, require precise surgical repair.
- Arthroscopic one-bone tunnel transosseous repair is a common technique for TFCC avulsion injuries.
- Accurate drill guide positioning is crucial for successful foveal insertion targeting.
Purpose of the Study:
- To determine optimal drill guide positioning over the TFCC articular disc.
- To achieve accurate targeting of the TFCC foveal insertion during arthroscopic repair.
- To utilize radiographic and MRI analysis for precise surgical planning.
Main Methods:
- Retrospective review of 60 patients with Palmer type 1B TFCC tears.
- Analysis of postoperative radiographs to measure bone tunnel parameters (start point, angle, length).
- Preoperative MRI scans used to predict drill guide tip position based on radiographic data.
Main Results:
- Mean bone tunnel starting point: 12.0 mm proximal to ulnar styloid.
- Average bone tunnel angle: 37.0°, average length: 10.0 mm.
- MRI indicated optimal drill guide tip position: 4.0 mm radial to ulnar styloid medial aspect, on the TFCC articular disc.
Conclusions:
- Radiologic and anatomic parameters provide guidance for TFCC drill guide positioning.
- A practical landmark (lateral one-third of a line between sigmoid notch and ulnar styloid centers) optimizes bone tunnel placement.
- This method enhances targeting accuracy for the TFCC foveal insertion during arthroscopic repair.
