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Arthroscopic-Assisted Outside-In Repair of Triangular Fibrocartilage Complex Tears

February 19, 2016

Contributors: John J Fernandez, MD; Mark S Cohen, MD; Robert W Wysocki, Jr MD; Rachel M Frank, MD; Rachel M Frank, MD

Wrist arthroscopy is an increasingly common procedure utilized in orthopaedic surgery. With advances in surgical instrumentation and techniques, as well as expanding surgical indications wrist arthroscopy is now being used to treat a variety of conditions previously managed only with open techniques. Triangular fibrocartilage complex (TFCC) injuries remain among the most common causes of ulnar-sided wrist pain, and can result from both acute and chronic mechanisms of injury. The most common mechanism of acute injury to the TFCC is via a fall onto an outstretched hand with the wrist in a supinated, extended position. Patients with unrelenting pain, swelling, and/or mechanical symptoms despite a concerted effort at nonoperative management, which often consists of bracing, therapy, and/or injections, are often indicated for surgical intervention. Treatment historically consisted of open exploration and repair, however more recently, arthroscopic-assisted and all-arthroscopic techniques have been described. In this video we describe a safe, reproducible, and reliable surgical technique for arthroscopic-assisted outside-in repair of peripheral TFCC tears. The background, basic science, typical patient presentation, imaging findings, techniques, rehabilitation protocol, and clinical outcomes will be reviewed in detail. In addition, a specific focus on surgical anatomy, including pearls and pitfalls for protecting the dorsal sensory branch of the ulnar nerve, will be presented.

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