Triangular Fibrocartilage Complex (TFCC) Tears: Ulnar Tunnel Foveal Repair

Triangular Fibrocartilage Complex (TFCC) Tears: Ulnar Tunnel Foveal Repair

This video will demonstrate a repair of the wrist’s T F C C, the triangular fibrocartilage complex. The procedure will be performed on a cadaver. It will be done using the assistance of an arthroscopic camera and instruments. Suture and a bone anchor will be used for the repair. A cadaveric right hand is shown. The surgeon will make a small incision over the wrist near the radius bone for the small camera. The camera will then be placed in this incision and will view the wrist joint directly.

Once the camera is inserted, another small incision will create a portal where instruments may be used. This incision is just above the ulna and close to the TFCC. A probe will be inserted in this hole to test for a tear in the TFCC. Once completed, the probe is removed, and a drill guide is placed in this same incision. The tip of the guide is shown being placed on the TFCC. A sleeve in the guide is pushed forward against the wrist. The surgeon will use this location to mark the placement for the final incision.

The final skin incision will be made just over the end of the ulna. A tendon in this area will be moved away with a surgical retractor. The drill guide and sleeve will then be inserted into the 2 open incisions near the ulna. A temporary wire will be drilled through the guide sleeve and advanced until its tip is shown next to the tip of the guide. Another temporary wire is then passed alongside the first wire and will exit on the other side of the guide tip through the TFCC. This wire is then removed and replaced with a long needle.

Here, the needle is shown exiting the same hole as the recently removed wire. The other wire is also removed and replaced with a long needle. The wires are swapped for needles, as the needles are hollow and will allow for the passage of sutures. The drill guide is then removed and slid over the 2 needles that will remain in place. A blue suture with a stiff end is then passed through 1 of the needles. The needle will be pulled slightly back to help ensure the suture is in the joint space.

An instrument called a suture hook will be placed in the working incision. The hook grabs the end of the suture to pull more suture length through the joint. A wire with a loop will be placed in the other needle. The suture hook grabs the loop and the previously passed suture and pulls them out of the working incision. The blue suture is then passed through the loop of the wire. The other end of the wire is pulled, drawing the blue suture back into the incision. This creates a simple stitch that will hold the TFCC down.