All-Inside Suture Technique for Palmer Class 1B Triangular Fibrocartilage Repair

After completion of the diagnostic procedure, the ulnar-sided tear is identified and tear debridement is performed. A 1.5-cm incision is made to isolate the sensory branch of the ulnar nerve. This is made in the region of the 6U portal. The arthroscope is left in the 3-4 portal, and the slotted needle is inserted through the capsule wall, avoiding the isolated sensory ulnar branch, penetrating the ulnar-sided tear of the triangular fibrocartilage complex. A No. 2 PDS monofilament suture (Ethicon, Somerville, NJ) is inserted into the needle and visualized in the joint. The end of the suture is pulled through the 6R portal. The slotted needle is then removed and detached from the suture. The same needle is inserted through the tear about 0.3 cm from the point where the needle exited on the previous suture. The other end of the suture is inserted into the needle, and once visualized within the joint, it is withdrawn again through the 6R portal. In this way, we create an extra-articular loop with both ends of the same suture passing through the tear by way of the 6R portal. A knot is then tied and fixed inside the joint on the ulnar side of the triangular fibrocartilage complex. By use of the same technique, 2 or 3 more stitches can be placed, improving tear security.