Clinical Outcomes of Arthroscopic All-inside Knotless Fovea Repair Treating Atzei Type II and III Triangular Fibrocartilage Complex Tear

Foveal attachment of the triangular fibrocartilaginous complex (TFCC) is essential for distal radioulnar joint stability. Controversy still exists as to which is the best treatment in case of foveal lesions. Actual arthroscopic techniques either require mini open steps or are complex and expensive. A simple all inside knotless repair was introduced to provide a strong bony fixation in the fovea. This study is to evaluate the clinical outcomes in patients of TFCC tear, Atzei type II and III, underwent all-inside arthroscopic fovea repair with one knotless anchor.

From 2019 to 2023, 38 patients presenting with Palmer 1B, Atzei II and III lesions of the TFCC were operated on with this technique. Clinical evaluation was based on a compared measurement of the grip strength, pain on a visual analogic scale (VAS), different ranges of motion, and distal radioulnar joint (DRUJ) stability. Functional scores including Mayo modified wrist score (MMWS) and Quick disability arm, shoulder and hand (DASH) were also evaluated.

On postoperative evaluation, pain was reduced by 4.5 points and grip strength averaged 84% of the unaffected side. Range of motion averaged 92% on the unaffected side. Average values of MMWS and Quick Dash were 83.4 and 17.8. There are no major complications or lesions of the dorsal sensory branch of the ulnar nerve.

Arthroscopic all-inside knotless fovea repair could be an alternative treatment in Atzei type II and III lesions of the TFCC. This minimal-invasive fashion can provide benefits regarding healing potentials and cosmetics.