Outside-in Repair of Peripheral Triangular Fibrocartilage Complex Tears

Tears of the triangular fibrocartilage complex (TFCC) are common sources of ulnar-sided wrist pain within athletics that frequently go unrecognized or are diagnosed simply as wrist “sprains.” TFCC injuries vary along a wide spectrum based on acuity and location. Although degenerative tears are often associated with ulnar impaction and are usually best treated with debridement or joint leveling procedures, acute tears of the peripheral portion of the TFCC have been shown to have adequate blood supply and the potential to heal, analogous to the meniscus of the knee. Multiple open and arthroscopic TFCC repair techniques have been described with good results. The outside-in technique described here is most useful in cases of acute tears at the ulnar periphery of the TFCC (type IB), with isolated ulnar-sided wrist pain and no signs or symptoms of distal radioulnar joint instability.