Triangular Fibrocartilage Complex (TFCC) Tears: Open Foveal Repair

Triangular Fibrocartilage Complex (TFCC) Tears: Open Foveal Repair

This video will provide a cadaveric demonstration of a repair to the wrist’s T F C C, also known as the triangular fibrocartilage complex. The surgeon will first diagnose and assess the tear using a small camera and then make a larger incision to perform the repair using suture and a bone anchor. Here is a cadaveric right wrist. The first 2 small incisions will be made for the arthroscopic instruments. The camera will be placed in the first incision, pointed towards the ulnar side of the wrist.

Here, the surgeon shows the view from the camera inside the wrist joint. This is the TFCC. A probe will be inserted to test the articular disc for a tear. When the probe is placed under the disc, significant motion is seen, indicating a tear to the outer portion of the TFCC. Now that the tear is diagnosed, the surgeon will transition to the treatment portion of the surgery. An incision will be made directly over the end of the ulna bone. Using a surgical retractor, the nearby tissues will be moved so the surgeon can see the TFCC.

Here, the surgeon is identifying the tear of the TFCC, just above the ulna. A high-strength suture will be passed through the TFCC. The ends of the suture will be tacked down to the bone using a small bone anchor. Before placing the bone anchor to hold the suture, a drill will be used to place a small hole in the ulna bone. Then, the 2 ends of the suture will be fed into the hole at the end of the bone anchor. While pulling tension on the suture ends, the end of the small anchor, with the attached sutures, will be placed into the bone.

A mallet will be used to sink the anchor into the bone. Once that is completed, the handle to the anchor will be removed. The strength of the anchor and sutures will be assessed, and the 2 ends of the suture will be cut. The TFCC is now taut to the bone. The surgeon will then repair the edges of the TFCC using a suture. The TFCC will be sewn to the nearby capsule of tissue that surrounds this area and tied in a secure knot. The surgeon will cut the ends of the extra suture. This process will be repeated for the other edge of the tear.

The capsule of tissue surrounding the TFCC will then be tightly closed with a suture. Several deep layers of tissue will be closed before the surgeon sutures the skin. Once complete, the wrist will be placed into a splint. The surgery is now complete.