IntroductionAppreciation of the role of triangular fibrocartilage complex (TFCC) tears in ulnar sided wrist pain has significantly increased over the past several years. Arthroscopic repairs of Palmer 1B TFCC tears have been the standard option at our institution now for the past fourteen years. The purpose of this study was to evaluate our current technique, which has evolved over the years, to determine the long term efficacy of this shuttle relay technique.MethodsDiagnostic wrist arthroscopy is performed using a 2.7mm arthroscope through the 3-4 and 4-5 portals. The shaver is used to freshen the leading edge of the torn peripheral TFCC and the ulnotriquetral ligament complex. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between FCU and ECU. The spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one arm of the suture through the peripheral tear and out the 4-5 portal cannula. A second spinal needle is then placed in a parallel fashion to the first and the shuttle relay is passed through this needle. The shuttle relay is grasped and again brought out through the 4-5 portal and used to deliver the second arm of the suture back through the safe zone along the ulnar aspect of the wrist. This creates a mattress suture repair which is tied after division of the skin bridge and gentle spreading of the tissue down to capsule. The patient is then place into a well-molded short arm cast for 6 weeks.ResultsOur series includes 140 patients with greater than 24 month follow up. These patients have an average score of 95 with a range of 80-100. Complications have included 9 patients with transient numbness along the dorsal cutaneous branch of the ulnar nerve, two patients that required removal of the suture knot from the repair because of local irritation, one late localized wound infection from knot irritation through the skin and two cases of RSD. We currently are using a braided absorbable suture that is softer and absorbs more quickly to help prevent some of these complications in the future.ConclusionAs is suggested by the average Mayo Modified Wrist Score of 95, these patients have done extremely well in regards to their ability to return to pre injury activity. This has included a large group of athletes including high school, college and professional athletes. There are several techniques currently being used for repair of peripheral TFCC tears. Several of the orthopaedic equipment companies also make specific kits for repair of TFCC tears. In the era of cost containment, the shuttle relay technique is a viable option that is simple to perform, inexpensive and allows for excellent results when the surgeon is faced with a patient with a peripheral TFCC tear. IntroductionAppreciation of the role of triangular fibrocartilage complex (TFCC) tears in ulnar sided wrist pain has significantly increased over the past several years. Arthroscopic repairs of Palmer 1B TFCC tears have been the standard option at our institution now for the past fourteen years. The purpose of this study was to evaluate our current technique, which has evolved over the years, to determine the long term efficacy of this shuttle relay technique. Appreciation of the role of triangular fibrocartilage complex (TFCC) tears in ulnar sided wrist pain has significantly increased over the past several years. Arthroscopic repairs of Palmer 1B TFCC tears have been the standard option at our institution now for the past fourteen years. The purpose of this study was to evaluate our current technique, which has evolved over the years, to determine the long term efficacy of this shuttle relay technique. MethodsDiagnostic wrist arthroscopy is performed using a 2.7mm arthroscope through the 3-4 and 4-5 portals. The shaver is used to freshen the leading edge of the torn peripheral TFCC and the ulnotriquetral ligament complex. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between FCU and ECU. The spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one arm of the suture through the peripheral tear and out the 4-5 portal cannula. A second spinal needle is then placed in a parallel fashion to the first and the shuttle relay is passed through this needle. The shuttle relay is grasped and again brought out through the 4-5 portal and used to deliver the second arm of the suture back through the safe zone along the ulnar aspect of the wrist. This creates a mattress suture repair which is tied after division of the skin bridge and gentle spreading of the tissue down to capsule. The patient is then place into a well-molded short arm cast for 6 weeks. Diagnostic wrist arthroscopy is performed using a 2.7mm arthroscope through the 3-4 and 4-5 portals. The shaver is used to freshen the leading edge of the torn peripheral TFCC and the ulnotriquetral ligament complex. Percutaneous placement of an 18-gauge spinal needle is then placed in the safe zone along the ulnar aspect of the wrist between FCU and ECU. The spinal needle pierces the ulnotriquetral ligament and the leading edge of the torn peripheral TFCC. A shuttle relay is then passed through the spinal needle and brought out the cannula in the 4-5 portal using a grasper. The shuttle relay is then used to pull one arm of the suture through the peripheral tear and out the 4-5 portal cannula. A second spinal needle is then placed in a parallel fashion to the first and the shuttle relay is passed through this needle. The shuttle relay is grasped and again brought out through the 4-5 portal and used to deliver the second arm of the suture back through the safe zone along the ulnar aspect of the wrist. This creates a mattress suture repair which is tied after division of the skin bridge and gentle spreading of the tissue down to capsule. The patient is then place into a well-molded short arm cast for 6 weeks. ResultsOur series includes 140 patients with greater than 24 month follow up. These patients have an average score of 95 with a range of 80-100. Complications have included 9 patients with transient numbness along the dorsal cutaneous branch of the ulnar nerve, two patients that required removal of the suture knot from the repair because of local irritation, one late localized wound infection from knot irritation through the skin and two cases of RSD. We currently are using a braided absorbable suture that is softer and absorbs more quickly to help prevent some of these complications in the future. Our series includes 140 patients with greater than 24 month follow up. These patients have an average score of 95 with a range of 80-100. Complications have included 9 patients with transient numbness along the dorsal cutaneous branch of the ulnar nerve, two patients that required removal of the suture knot from the repair because of local irritation, one late localized wound infection from knot irritation through the skin and two cases of RSD. We currently are using a braided absorbable suture that is softer and absorbs more quickly to help prevent some of these complications in the future. ConclusionAs is suggested by the average Mayo Modified Wrist Score of 95, these patients have done extremely well in regards to their ability to return to pre injury activity. This has included a large group of athletes including high school, college and professional athletes. There are several techniques currently being used for repair of peripheral TFCC tears. Several of the orthopaedic equipment companies also make specific kits for repair of TFCC tears. In the era of cost containment, the shuttle relay technique is a viable option that is simple to perform, inexpensive and allows for excellent results when the surgeon is faced with a patient with a peripheral TFCC tear. As is suggested by the average Mayo Modified Wrist Score of 95, these patients have done extremely well in regards to their ability to return to pre injury activity. This has included a large group of athletes including high school, college and professional athletes. There are several techniques currently being used for repair of peripheral TFCC tears. Several of the orthopaedic equipment companies also make specific kits for repair of TFCC tears. In the era of cost containment, the shuttle relay technique is a viable option that is simple to perform, inexpensive and allows for excellent results when the surgeon is faced with a patient with a peripheral TFCC tear.