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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

2016 AWARD WINNER Wrist arthroscopy is an increasingly common procedure in orthopaedic surgery. With advances in surgical instrumentation and techniques and expanding surgical indications, wrist arthroscopy currently is used to manage various conditions previously managed via open techniques. Triangular fibrocartilage complex injuries are among the most common causes of ulnar-sided wrist pain and may result from acute and chronic mechanisms of injury. The most common mechanism of acute injury to the triangular fibrocartilage complex is a fall onto an outstretched hand with the wrist in supination and extension. Surgical treatment often is indicated in patients with unrelenting pain, swelling, and/or mechanical symptoms after a trial of nonsurgical treatment, which often consists of bracing, therapy, and/or injections. Historically, surgical treatment consisted of open exploration and repair; however, arthroscopic-assisted and all-arthroscopic techniques recently have been described. This video describes a safe, reproducible, and reliable surgical technique for arthroscopic-assisted outside-in repair of peripheral triangular fibrocartilage complex 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.