Chen Wei-Jen
Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, ChangHua, Taiwan, Republic of China.
Arthrosc Tech. 2017 Jan 16;6(1):e57-e64. doi: 10.1016/j.eats.2016.09.004. eCollection 2017 Feb.
The radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. Traditionally, arthroscopic techniques of the TFCC repair are suturing the ulnar-sided disruption peripherally to the dorsal or ulnar capsule instead of suturing the TFCC to the fovea and thus fail to restore the DRUJ stability if the TFCC is detached from the fovea. Recently, some arthroscopic foveal repair techniques have been reported using a suture anchor or transosseous sutures to address the foveal tear. This technical note describes an arthroscopic transosseous technique to reattach the foveal-disrupted TFCC. A 1.6-mm small osseous tunnel is created on the radial border of the fovea and 4 sutures are passed into the tunnel by using a 16-gauge needle. The TFCC could be sutured arthroscopically with these 4 sutures and be compressed against the fovea. Our technique provides not only a good suture construct for TFCC foveal reattachment but also an anatomic contact surface between the torn TFCC and its foveal footprint for healing. We recommend this technique as an alternative for repairing TFCC foveal tear.
三角纤维软骨复合体（TFCC）的桡尺韧带，尤其是插入尺骨凹的深层纤维，是下尺桡关节（DRUJ）稳定的关键组成部分。TFCC凹部插入处的创伤性损伤会导致DRUJ不稳定。传统上，TFCC修复的关节镜技术是将尺侧撕裂处外周缝合至背侧或尺侧关节囊，而不是将TFCC缝合至尺骨凹，因此如果TFCC从尺骨凹脱离，则无法恢复DRUJ的稳定性。最近，已有一些使用缝合锚钉或经骨缝线的关节镜下尺骨凹修复技术的报道，用于处理尺骨凹撕裂。本技术说明描述了一种关节镜下经骨技术，用于重新附着尺骨凹处断裂的TFCC。在尺骨凹的桡侧边缘制作一个1.6毫米的小骨隧道，使用16号针将4根缝线穿入该隧道。可以通过这4根缝线在关节镜下缝合TFCC，并将其压在尺骨凹上。我们的技术不仅为TFCC尺骨凹重新附着提供了良好的缝合结构，而且为撕裂的TFCC与其尺骨凹足迹之间提供了一个解剖接触表面以促进愈合。我们推荐该技术作为修复TFCC尺骨凹撕裂的一种替代方法。
