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

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

This animated video will demonstrate the repair of a tear in the wrist’s T F C C, also known as the triangular fibrocartilage complex. A knotless repair technique utilizing suture and a bone anchor will be performed. This is a minimally invasive arthroscopic technique that uses a small camera and instruments to assist in the repair. The TFCC tear is demonstrated here, overlying the ulna bone in the left wrist.

Three small incisions will be made to introduce the instruments for the repair. A camera will be inserted in this incision and directed towards the TFCC to visualize the tear. The 2 small incisions on the outside of the wrist will be used to place an aiming drill guide which will be used to make a small tunnel in the ulna bone. Once the aiming guide is in place, a small temporary wire will be advanced through the guide, bone, and torn TFCC. The aiming guide will be removed, and the wire will be left in place.

A hollow-bodied drill bit will then be placed over the wire, and a tunnel will be drilled. A strong blue suture with a stiff end will be loaded into a suture passer and will be placed into the newly created tunnel and advanced beyond the tear in the TFCC. It will be twisted in a corkscrew fashion around the passer before the suture passer is removed, leaving an available portion to access later. Then, a small wire with a loop at the end will be loaded onto the suture passer and passed through the hole.

Both the blue suture and the wire will be retrieved with an instrument through 1 of the initial incisions made on the top of the wrist. The blue suture is then threaded through the loop of the metal wire. They are then pulled back through the other end of the tear and tunnel. This creates a flat loop from the blue suture that will hold the tear fragment down. Then, a drill will be used to make a small hole under the tunnel in the ulna in preparation of placing a bone anchor to hold the suture ends down. The drill will be removed.

The blue suture will be placed into the eyelet, or small hole, at the top of the anchor. The anchor and suture are then placed into the bone and tensioned tightly to create a low-profile repair without a suture knot in the TFCC tear. The surgery is now complete, and the small incisions will be closed.