A Novel Technique of All-Inside Arthroscopic Triangular Fibrocartilage Complex Repair

Peripheral triangular fibrocartilage complex (TFCC) tears are amenable to repair. Limitations of current repair techniques include prolonged recovery and button or knot intolerance. We present a novel technique of an all-inside repair using existing technology (FasT-Fix; Smith & Nephew Endoscopy, Andover, MA) to circumvent these complications. This technique is faster, easily performed, safe, and potentially stronger than current repairs. Earlier motion and rehabilitation are instituted after this repair. The tear is debrided to stimulate angiogenesis. The FasT-Fix is inserted through the 3-4 portal with the arthroscope in the 6R portal. The first poly-L-lactic acid block is deposited peripheral to the tear. Upon penetration of the wrist capsule, a distinct decrease in resistance is felt. The introducer is withdrawn, depositing the block outside the capsule. The trigger on the introducer advances the second block into the deployment position. It is advanced and deposited central to the tear, forming a vertical mattress configuration. The introducer is removed, leaving the pre-tied suture. The knot is tightened and cut by use of the knot pusher/cutter. Multiple implants may be inserted to complete the repair. Postoperative care involves a sugartong splint for 2 weeks followed by a short arm cast for 4 weeks. Range of motion is begun thereafter with strengthening started at 10 weeks.     

Arthroscopic Suture Repair of Peripheral Tears of Triangular Fibrocartilage Complex Using a Volar Portal

Surgical repair of a Palmer type IB triangular fibrocartilage complex (TFCC) tear can be difficult using conventional dorsal portals and it may need special repair kits. The authors describe an arthroscopic technique using an additional volar portal that allows quick access and a secure purchase of peripheral TFCC tears as well as a distinct approach to dorsal wrist structures.     

腕关节三角纤维软骨复合体损伤的关节镜治疗

目的：对外伤性腕关节三角纤维软骨复合体(TFCC)损伤关节镜治疗后疗效评价。方法：选有急慢性外伤史的13例14侧腕关节三角纤维软骨复合体损伤病例，年龄21～45岁，平均28．3岁。经关节造影、物理检查及MRI检查有异常者施行关节镜检查，其中8例TFCC中心性撕裂在关节镜下行游离边缘切除术，5例6侧TFCC边缘部撕裂施行缝合修复术，术后平均随访28个月。利用Green-O’Brien功能评定方法。结果：优9例，良3例，可2例。其中12例疗效良好以上者恢复原来工作。结论：对腕关节三角纤维软骨复合体损伤关节镜治疗是明确诊断及术后可以得到良好疗效并早期康复的一种有效术式。