Suture techniques for TFCC

Abstract

Traumatic ruptures of the triangular fibrocartilaginous complex (TFCC) may cause ulnar-sided wrist pain. These ruptures frequently lead to instability of the distal radioulnar joint (DRUJ) because the ulnoradial ligaments, which are interwoven with the TFCC, are avulsed from the fovea of the ulnar head or—very rarely—from the radius. Conservative treatment may be sufficient, and some instability may be tolerated over time. In the case of persistent pain, operative repair by reattachment of the TFCC and, thereby, the ligaments to the previously debrided bone in the fovea is effective in reestablishing a stable, pain free DRUJ. Several arthroscopic and open repair techniques have been described in the last years. Contraindications such as the ulna—plus—situation or instability due to even minor degrees of malunion after fractures of the forearm bones must be kept in mind. An overview is given of the pathological anatomy, diagnosis, indications and suturing techniques.