Arthroscopic Triangular Fibrocartilage Complex Repair Using Modified Outside-In Technique.

Arthroscopic triangular fibrocartilage complex (TFCC) repair is a standard technique to repair the peripheral tears of the TFCC. Palmer and Werner first described the TFCC. TFCC tears are a major cause of ulnar side wrist pain. Palmer classified TFCC tears as traumatic (type 1) and degenerative (type 2). Type 1 was subdivided according to the anatomic site of tissue disruption, whereas type 2 was based on the extent of the degenerative process. The acute TFCC tears result from the shear or compressive forces between the proximal carpus and the distal ulna, whereas chronic tears are the result of positive ulnar variance with or without a preceding traumatic event. We describe a method of outside-in repair using an inline 21-gauge hypodermic needle with a 2-0 PDS suture, gaining a distinct advantage of a smaller hole in the TFCC and thus rendering the repair less traumatic, safe, and reproducible for the peripheral tears.