Arthroscopic complex TFCC repair using a large one-bone tunnel technique

Introduction 

The triangular fibrocartilage complex (TFCC) is essential for maintaining distal radioulnar joint (DRUJ) stability. Tears in the TFCC, particularly those involving the foveal attachment (proximal component), can lead to significant instability, often necessitating surgical repair. While primary TFCC repairs are generally effective, some cases present with complex tear patterns and may require revisional surgery due to persistent symptoms or failed initial operation. The arthroscopic large one-bone tunnel technique offers several advantages for these complex and challenging cases, providing a more robust, anatomically precise repair option with improved healing potential. 

Technique and Advantages 

The large one-bone tunnel technique involves creating a 4mm transosseous tunnel, through which sutures are passed to secure the complex TFCC tear. This technique allows for sufficient contact between the torn ends of TFCC and its insertion site. This technique also provide improved healing potential by autonomously refreshes the fibrosed and retracted torn end of TFCC and the bone footprint, eliminating the need for additional preparation process. Additionally, the large bone tunnel allows for the placement of multiple sutures, enabling the repair of complex TFCC tears at each tear site. The suturing method can be adapted for proximal component-only repair, simultaneous proximal and distal component repair, limb-specific repair, or a combination of these techniques. When the torn portion is distant from the bone tunnel, a combination of the bone tunnel suturing technique and passing over the styloid process can facilitate the convenience of repair. 

Clinical Outcomes 

Clinical results have shown significant improvements in pain relief and range of motion in patients treated with the large one-bone tunnel technique, even in revisional surgeries following previously failed TFCC repairs. DRUJ stability is reliably restored, and patients typically return to their previous activity levels without restriction. This technique has proven effective even in cases where initial repairs were considered irreparable, demonstrating its value in complex tear patterns. 

Conclusion 

The arthroscopic large one-bone tunnel technique offers a superior alternative for complex TFCC tears and revisional TFCC surgery, providing abundant flexibility in technical modifications. Its ability to achieve anatomically precise and stable repairs with improved healing potential positions it as a preferred method for surgeons dealing with difficult TFCC tears.