DRUJ Instability: Arthroscopic Ligament Reconstruction

  • Andrea Atzei


The triangular fibrocartilage complex (TFCC) is a specialized tridimensional structure, composed by a “proximal component” that inserts into the fovea ulnaris and is responsible for the stability of the distal radioulnar joint (DRUJ). Though frequently overlooked, the foveal area is of outmost importance also for the stability of the ulnar carpus, since it provides insertion to the ulnocarpal (UC) ligaments as well. Massive rupture of the TFCC or degenerated TFCC margins of chronic peripheral tears usually cause DRUJ and UC instability that are not repairable by direct suture, but require ligament reconstruction.

Using a tendon graft, that is passed through a bone tunnel in the radius and ulna and through the UC ligaments’ interval, the arthroscopic technique allows accurate restoration of joint stability and normal functional biomechanics of the ulnar carpus. The arthroscopic technique of TFCC reconsttruction allows greater accuracy and minimized surgical trauma so that reduced postoperative pain may facilitate postoperative rehabilitation and may allow for an improved overall functional


Distal Radius Tendon Graft Posterior Interosseous Nerve Ulnar Head Pronator Quadratus 
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.
    Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27:243–251PubMedCrossRefGoogle Scholar
  2. 2.
    Atzei A (2009) New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur 34E:582–591Google Scholar
  3. 3.
    Atzei A, Luchetti R (2005) Clinical approach to the painful wrist. In: Geissler WB (ed) Wrist arthroscopy. Springer/LLC, New York, pp 185–195CrossRefGoogle Scholar
  4. 4.
    Atzei A, Luchetti R, Borelli PP, Sgarbossa A, Cugola L (2006) Arthroscopic TFCC reconstruction by tendon graft. Rivista di Chirurgia della Mano 43:370–376Google Scholar
  5. 5.
    Atzei A, Rizzo A, Luchetti R, Fairplay T (2008) Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 12:226–235PubMedCrossRefGoogle Scholar
  6. 6.
    Boyes JH (1970) Surgical repair of joints. In: Bunnell S (ed) Bunnell’s surgery of the hand. Lippincott, Philadelphia, pp 294–313Google Scholar
  7. 7.
    Breen TF, Jupiter JB (1989) Extensor carpi ulnaris and flexor carpi ulnaris tenodesis of the unstable distal ulna. J Hand Surg Am 14:612–617PubMedCrossRefGoogle Scholar
  8. 8.
    del Piñal F, Garcia Bernal FJ, Pisani D, Regalado J, Ayala H, Studer A (2007) Dry arthroscopy of the wrist: surgical technique. J Hand Surgery Am 32A:119–123CrossRefGoogle Scholar
  9. 9.
    del Piñal F, García-Bernal FJ, Cagigal L, Studer A, Regalado J, Thams C (2010) A technique for arthroscopic all-inside suturing in the wrist. J Hand Surg Eur 35E(6):475–479Google Scholar
  10. 10.
    Eliason EL (1932) An operation for recurrent inferior radioulnar dislocation. Ann Surg 96:27–35PubMedCrossRefGoogle Scholar
  11. 11.
    Fulcher S, Poehling G (1998) The role of operative arthroscopy for the diagnosis and treatment of lesions about the distal ulna. Hand Clin 14:285–296PubMedGoogle Scholar
  12. 12.
    Hermansdorfer JD, Kleinman WB (1991) Management of chronic peripheral tears of the triangular fibrocartilage complex. J Hand Surg Am 16:340–346PubMedCrossRefGoogle Scholar
  13. 13.
    Hui FC, Linscheid RL (1982) Ulnotriquetral augmentation tenodesis: a reconstructive procedure for dorsal subluxation of the distal radioulnar joint. J Hand Surg Am 7:230–236PubMedGoogle Scholar
  14. 14.
    Johnson RK, Shrewsbury MM (1976) The pronator quadratus in motions and in stabilization of the radius and ulna at the distal radioulnar joint. J Hand Surg Am 1:205–209PubMedGoogle Scholar
  15. 15.
    King GJ, McMurtry RY, Rubenstem JD, Gertzbein SD (1986) Kmematlcs of the distal radioulnar joint. J Hand Surg Am 11A:798–804Google Scholar
  16. 16.
    Mansat M, Mansat Ch, Martinez Ch (1983) L’articulation radio-cubitale inférieur. Pathologie traumatique. Le poignet. pp 187–195Google Scholar
  17. 17.
    Moritomo H, Murase T, Arimitsu S, Oka K (2008) Change in the length of the ulnocarpal ligaments during radiocarpal motion: possible impact on triangular fibrocartilage complex foveal tears. J Hand Surg Am 33A:1278–1286CrossRefGoogle Scholar
  18. 18.
    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
  19. 19.
    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 25B:479–486Google Scholar
  20. 20.
    Nakamura T, Yabe Y, Horiuchi Y (1996) Functional anatomy of the triangular fibrocartilage complex. Hand Surg 21:581–586Google Scholar
  21. 21.
    Nakamura T, Sato K, Okazaki M, Toyama Y, Ikegami H (2011) Repair of foveal detachment of the triangular fibrocartilage complex: open and arthroscopic transosseous techniques. Hand Clin 27:281–290PubMedCrossRefGoogle Scholar
  22. 22.
    Pederzini L, Luchetti R, Soragni O, Alfarano M, Montagna G, Cerofolini E, Colombini R, Roth J (1992) Evaluation of the triangular fibrocartilage complex tears by arthroscopy, arthrography, and magnetic resonance imaging. Arthroscopy 8:191–197PubMedCrossRefGoogle Scholar
  23. 23.
    Schuind F, An KN, Berglund L et al (1991) The distal radioulnar ligaments a biomechanical study. J Hand Surg Am 16A:1106–1114CrossRefGoogle Scholar
  24. 24.
    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
  25. 25.
    Tsai TM, Stilwell JH (1984) Repair of chronic subluxation of the distal radioulnar joint (ulnar dorsal) using flexor carpi ulnaris tendon. J Hand Surg Br 9:289–294PubMedCrossRefGoogle Scholar
  26. 26.
    Zanetti M, Bram J, Hodler J (1997) Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging 7:590–594PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Fenice Hand Surgery and Rehabilitation Team, Centro di Medicina, Treviso - Italy; Policlinico “San Giorgio”PordenoneItaly

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