Triangular Fibrocartilage Complex Repair Through Bone Tunnels (Palmer Type 1D)

The triangular fibrocartilage complex (TFCC) is an important and complex anatomic structure. At the distal radioulnar joint (DRUJ), the TFCC provides mechanical stability and absorbs axial and translational forces. Discrete anatomic structures impart specific functions. By adulthood, the blood supply is limited to the peripheral border, and the radial origin of the TFCC has minimal vascularity. Acute traumatic tears frequently follow high-force injuries onto an outstretched hand and are classified according to Palmer. Tears occurring along the radial border of the TFCC (Palmer class 1D) have poor healing potential because of the lack of vascularity. Magnetic resonance arthrogram has high sensitivity and specificity for TFCC injuries. Palmer class 1D lesions are identified by standard wrist arthroscopy. TFCC tears are debrided, with the radial TFCC origin is resected to bleeding bone. Meniscal repair sutures are carefully placed through the TFCC via an ulnar-based cannula. Bone tunnels are then created in the appropriate orientation, and the sutures are passed through the radius. A small radial-sided incision is made overlying the exiting sutures, which are tensioned and tied over bone or a biotenodesis screw. Patients are immobilized in a long-arm splint for 2 weeks followed by a graduated rehabilitation program.