gms | German Medical Science

Objectives/Interrogation: The TFCC stabilizes the DRUJ, provides a cushion between the ulnar head and the lunate with axial loading and ulnar deviation of the wrist, and it is an efficient ulnar-side restrain to the carpus. Extensive Radial side tears and combined massive radial and central tears without DRUJ instability are still a challenge to treat. We describe an all-inside arthroscopic dermal allograft reconstruction that restores the radial insertion, the central disk (meniscus homologue) while enhancing the support for the dorsal and volar radioulnar ligaments.

Methods: The concept of this technique is based on the optimal results obtained with the SCR (Superior Capsular Reconstruction) for massive rotator cuff substance loss in the shoulder. Biomechanical and prospective clinical studies have demonstrated the benefits of this reconstruction in the subacromial space. We used the standard 3-4, 4-5 and 6R portals for this reconstruction. The massive radial and central tears with significant substance loss are debrided, and DRUJ stability is assessed. A knotless reconstruction is then accomplished by inserting FiberWire (Arthrex, Inc. - Naples, FL) preloaded SutureTak anchors (Arthrex, Inc. - Naples, FL) on the dorsal and volar corners of the radial wall. Intra-articular measures are taken from volar to dorsal and from radial to ulnar to determine the perfect size for the allograft. The allograft is tagged and brought inside the joint. A tight knotless radial fixation is completed, the new meniscus homologue covers the ulnar head and peripheral fixation is finalized via a standard ulnar tunnel foveal technique. The specimens were tested for axial load, ulnar deviation, and forearm pronation.

Results and Conclusions: This is the first study looking into an all-arthroscopic allograft TFCC reconstruction. The dermal allograft did not get displaced or got torn when the wrist was taken from radial to ulnar deviation, forearm rotation, or when axial load was applied from the carpus down to the ulna. This type of reconstruction could also be combined with an arthroscopic wafer when ulnocarpal abutment is present. The combination of these two procedures might expedite the recovery time and return to previous activities when compared to an ulnar shortening osteotomy. The results of the on-going high repetition cyclic load will be presented as well. We believe this is a minimally and very reproducible technique, which might extend the bridge between reconstructive and salvage wrist procedures.