Arthroscopic refixation of TFCC by bone screw anchor

Abstract

The goal of this operation technique is astable refixation of the triangular fibrocartilage complex (TFCC) to the fovea ulnaris. The stability of the distal radio-ulnar joint (DRUJ) should be re-established. The patients pain and the feeling of instability should be reduced. Lesions of the foveal component of the TFCC resulting in DRUJ instability. Combined lesions of both components of the TFCC. Complete detachment of the TFCC from the ulna either without fracture of the styloid process of the ulna or with fracture (floating styloid). Severe lacerations of the TFCC and clinically relevant arthrosis of the DRUJ. Severely osteoporotic bone. Following diagnostic arthroscopy and performance of stability control of the TFCC with a palpation hook, reduction of the DRUJ with supination position of the wrist. Bone anchor fixation through the direct foveal portal (DF). Under arthroscopic control through the 3/4 portal, the suture from the DF portal is placed through the TFCC. Pull out and tie the strands through the 6U portal. Restriction of rotation of the forearm in aMunster cast or special cast brace for 6weeks. Self-controlled exercise of the wrist after 6weeks. Physiotherapy and strength building 8weeks postoperatively. Clinical studies of this technique showed asignificant amelioration of pain perception, improved range of motion and DASH score in all patients after anchor fixation. The results are comparable to other techniques. All patients returned to work after the operation. Accordingly, using this technique avery good stabilization of the DRUJ with low complications can be achieved.