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. 2021 Mar 24;16(1):210.
doi: 10.1186/s13018-020-02046-1.

All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

Mengchun Tsai  1 , Yi-Hsuan Lin  1   2 , Chih-Hao Chiu  1   2 , Chun-Ying Cheng  1   2 , Yi-Sheng Chan  1   2 , Alvin Chao-Yu Chen  3   4
Affiliations

All-arthroscopic repair of Atzei class II and III triangular fibrocartilage complex tears using the FasT-Fix suture device

Mengchun Tsai et al. J Orthop Surg Res. .

Abstract

Background: The study is aimed to propose an arthroscopic repair technique using a pre-tied suture device for peripheral TFCC (triangular fibrocartilage complex) tear with proximal component involvement.

Methods: Through a retrospective review in the medical records of patients who underwent unilateral arthroscopic repair for TFCC Palmer IB lesion between 2017 and 2019, 12 patients were arthroscopically diagnosed as proximal component tear and received more than 1 year follow-up postoperatively. The arthroscope was introduced from 6R portal to discriminate Atzei class II from III lesions by a "visualization test" and to supervise the repair procedure using pre-tied FasT-Fix suture device from 3-4 portal. Two poly-ether-ether-ketone (PEEK) blocks were further advanced along the device needle to finally seat outside the ulnar joint capsule, followed by gradually tightening the pre-tied suture loop until the TFCC periphery was securely repositioned and held stably.

Results: Operation time averaged 87 min. Hook test and DRUJ arthroscopy confirmed proximal component tear in all 12 wrists. Four patients were diagnosed to be Atzei class II lesion as full thickness tear of distal component was arthroscopically identified from 6R portal while the other 8 exhibited partial thickness tear and were categorized as class III lesion. Follow-up averaged 15 months with a range of 12 to 24 months. Mayo modified wrist score improved from an average of 61.3 preoperatively to 90.4 at the latest visit.

Conclusions: A modified technique for diagnosis and all-arthroscopic repair in TFCC Atzei class II and III lesions using a pre-tied suture device is a feasible and safe option with promising results.

Keywords: Arthroscopy; Distal radioulnar joint; Peripheral tear; Triangular fibrocartilage complex.

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Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Thirty-five-year-old male patient, left ulnar-sided wrist pain for 3 months after motorbike accident. a Arthroscopic view from 3-4 portal shows detachment of TFCC periphery (hollow arrows) from ulnar joint capsule (U). b Arthroscopic view from 6R portal shows Atzei class II TFCC lesion with direct “visualization” of ulnar head (white arrows)
Fig. 2
Fig. 2
FasT-Fix suture device application for the patient in Fig. 1. Arthroscopic viewing from 6R portal. a Introduction of FasT-fix needle (F) from 3-4 portal for piercing TFCC by holding the TFCC in tension with ethibond suture (black arrow). b FasT-fix needle (F) penetrating and beneath TFCC for advancing the PEEK block (white arrow) to reach the ulnar joint capsule (U). c FasT-fix needle (F) from 3-4 portal about to pierce TFCC slightly volar to the first pierce with polyester suture (S) (black arrow). d Polyether suture (S) with twice piercing passes beneath TFCC and penetrate the proximal component (Pc) with ethibond suture (black arrow) kept in tension
Fig. 3
Fig. 3
A suture loop was present at the periphery of TFCC; two suture limbs passed beneath the torn fiber and were distally locked with two poly-ether-ether-ketone (PEEK) blocks outside the ulnar joint capsule. Asterisk indicates a pre-tied polyester suture loop of the TFCC FasT-Fix device
See this image and copyright information in PMC

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