Arthroscopic inside-out suture technique with isometric suture method for TFCC foveal repair

Technique & methods: 3–4, 4–5 portal, DRUJ-R and DRUJ-U are created. 1.9 mm wrist arthroscope is used. The hook test, and the floating sign, in which TFCC around fovea is floating during suction with a shaver, is usually helpful to make decision from RCJ. TFCC foveal region is checked from DRUJ scope directly. From DRUJ-R, scope is inserted, and debridement is performed from DRUJ-U with shaver. If it is difficult to manage from dorsal side, shaver is inserted from direct fovea portal. 1.5cm longitudinal skin incision is made just volar to the ulnar styloid. Single lumen curved guide is inserted through the 4-5 portal, targeting the fovea. The isometric point is just dorsal and radial to the recess seeing from RCJ according to literature. In neutral or slightly supinated position, the needle through the curved guide is easier to aim towards the center of fovea because the ulnar styloid moves volar direction. Passing wire with suture tape is drilled via the curved guide through the TFCC and distal ulna bone and comes out on the ulnar aspect of ulna cortex, and fixed to ulnar cortex using Swieve Lock system. 100 patients were surgically treated for foveal tear. Plaster fixation with the arm neutral was applied for 3weeks. Active ROM starts from cast removal, and passive ROM starts 6 weeks after operation. 150 patients were evaluated with VAS, and modified Green &O’Brien scoring system.

Results: Averaged VAS improved from 8.8 to 0.8, and returned their previous work or sports. Clinical score with modified Green and O’Brien scoring system averaged 93.1 points.   

Conclusion: Recent reports suggested the TFCC at Fovea was great role on DRUJ stability. Our current results encourage the repair of the TFCC at Fovea arthroscopically. In spite of the good results, whether the factor of age (traumatic or degenerative), and duration from injury to surgical repair effect on the result was considered in the future problem.

Keywords: TFCC Arthroscope DRUJ