Peripheral Tear of the Triangular Fibrocartilage Complex from the Ulna: Arthroscopic Repair

Peripheral tear of the triangular fibrocartilage complex (TFCC) from its attachments to the ulna or the joint capsule.

May not restore stability to the distal radioulnar joint (DRUJ) in cases of advanced or chronic instability

The arthroscope is placed in the 3–4 or 4–5 portal depending on the size of the wrist and visualization.
A probe is inserted through the 6R or 6U portal. Loss of normal TFCC tension under probe pressure, the so-called trampoline test, is a sign of a peripheral tear.

When making portals, nick the skin and spread the subcutaneous tissue to prevent cutaneous nerve and tendon injury.

A 1.5 cm skin incision is made just dorsal to the ulnar styloid. The extensor retinaculum and extensor carpi ulnaris (ECU) subsheath are opened 1 cm and the tendon retracted enough to visualize the floor of the sixth compartment.

Protect any branches of the dorsal sensory ulnar nerve that pass nearby.

Second cannula can be placed to create either a horizontal mattress. (Fig. 17-1) or simple suture (Fig. 17-2) technique.
Pass a 2-0 polydioxanone suture through the first cannula and retrieve it through the second using a suture snare. Withdraw the cannulas (Fig. 17-1A, B,C).
In a similar fashion, place one or two additional sutures through the torn edge a few millimeters apart (Fig. 17-2A,B,C).
Tie the sutures over the floor of the subsheath (Fig. 17-2D).
Close the ECU subsheath and retinaculum.