DRUJ Instability: Arthroscopic Repair of the Detached TFCC to the Fovea of the Ulna

  • Toshiyasu Nakamura


Recent anatomical and biomechanical studies demonstrated that the triangular fibrocartilage complex (TFCC) is the primary stabilizer of the distal radioulnar joint (DRUJ); thus TFCC tear indicates DRUJ instability. Details of DRUJ instability have been gradually revealed, and rupture of the radioulnar ligament (RUL) at the fovea area, where is its main attaching portion to the ulna and is the isometric point during forearm rotation as the rotation axis passes, is responsible for DRUJ instability. Physical examination and image diagnosis can indicate foveal detachment of the TFCC, while DRUJ arthroscopy is superior to diagnose rupture of the RUL. Arthroscopically assisted repair technique and all arthroscopic transosseous repairs are described in this chapter, and both are promising techniques in the treatment of foveal disruption of the TFCC.


Suture Anchor Ulnar Styloid Ulnar Variance Forearm Rotation Extensor Retinaculum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Atzei A (2010) Arthroscopic management of DRUJ instability following TFCC ulnar tears. In: Del Pinal F, Mathoulin C, Luchetti R (eds) Arthroscopic management of distal radius fractures. Springer, Berlin/Heidelberg, pp 73–88CrossRefGoogle Scholar
  2. 2.
    Atzei A, Rizzo A, Luchetti R et al (2008) Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 12:226–235PubMedCrossRefGoogle Scholar
  3. 3.
    Haugstvedt JR, Berger RA, Nakamura T et al (2006) Relative contributions of the ulnar attachment of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg 26A:445–451Google Scholar
  4. 4.
    Haugstvedt JR, Husby T (1999) Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique. Scand J Plast Reconstr Surg 33:439–447CrossRefGoogle Scholar
  5. 5.
    Iwasaki N, Minami A (2009) Arthroscopically assisted reattachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head. J Hand Surg Am 34:1323–1326PubMedCrossRefGoogle Scholar
  6. 6.
    Lindau T, Adlercreutz C, Aspenberg P (2000) Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radius fractures. J Hand Surg Am 25:464–468PubMedCrossRefGoogle Scholar
  7. 7.
    Millants P, De Smet L, Van Ransbeeck H (2002) Outcome study of arthroscopic suturing of ulnar avulsion of the triangular fibrocartilage complex of the wrist. Chir Main 21:298–300PubMedCrossRefGoogle Scholar
  8. 8.
    Moriya T, Aoki M, Iba K et al (2009) Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur 34:219–223Google Scholar
  9. 9.
    Nakamura T, Makita A (2000) The proximal ligamentous component of the triangular fibrocartilage complex: functional anatomy and three-dimensional changes in length of the radioulnar ligament during pronation-supination. J Hand Surg Br 25:479–486PubMedGoogle Scholar
  10. 10.
    Nakamura T, Nakao Y, Ikegami H et al (2004) Open repair of the ulnar disruption of the triangular fibrocartilage complex with double 3D-mattress suturing technique. Tech Up Extrem Surg 8:116–123CrossRefGoogle Scholar
  11. 11.
    Nakamura T, Sato K, Okazaki M et al (2011) Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 27:281–290PubMedCrossRefGoogle Scholar
  12. 12.
    Nakamura T, Yabe Y (2000) Histological anatomy of the triangular fibrocartilage complex of the human wrist. Ann Anat 182:567–572PubMedCrossRefGoogle Scholar
  13. 13.
    Nakamura T, Yabe Y, Horiuchi Y (1996) Functional anatomy of the triangular fibrocartilage complex. J Hand Surg Br 21:581–586PubMedCrossRefGoogle Scholar
  14. 14.
    Nakamura T, Yabe Y, Horiuchi Y (1999) Fat-suppression magnetic resonance imaging of the triangular fibrocartilage complex – comparison with spin echo, gradient echo pulse sequence and histology. J Hand Surg Br 24:22–26PubMedCrossRefGoogle Scholar
  15. 15.
    Nakamura T, Yabe Y, Horiuchi Y et al (2001) Origins and insertions of the triangular fibrocartilage complex – a histological study. J Hand Surg Br 26:446–454PubMedCrossRefGoogle Scholar
  16. 16.
    Palmer AK, Werner FW (1981) The triangular fibrocartilage complex of the wrist -anatomy and function. J Hand Surg 6:153–162Google Scholar
  17. 17.
    Palmer AK (1989) Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 14:594–606PubMedCrossRefGoogle Scholar
  18. 18.
    Tay SC, Tomita K, Berger RA (2007) The “ulnar fovea sign” for defining ulnar wrist pain: an analysis of sensitivity and specificity. J Hand Surg Am 32:438–444PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySchool of Medicine, Keio UniversityShinjuku-ku, TokyoJapan

Personalised recommendations