Triangular fibrocartilage complex (TFCC) dorsal distal repair

The TFCC is an essential structure in the stability of the distal radio-ulnar joint (DRUJ). What we took for a simple suspensory ligament has actually become a complex structure than previously thought since the work of Palmer in 1981. Some members of the EWAS, first and foremost Toshiyasu Nakamura, has helped to better understand this essential component as well as the damage it may suffer. Thanks to Andrea Atzei, Francisco Del Pinal and Tommy Lindau, the TFCC is now a well understood and well-known entity. Having them together in a round table on this topic answering a flow of questions asked by our two famous chairmen, Diego Fernandez and Laurent Obert, allows to better understand the problems caused by the lesion of this structure.

Proximal pole necrosis of the scaphoid can occur after scaphoid fractures. The replacement of the proximal pole has been tried using many different materials for many years, according to the literature. This technique consists in an arthroscopic debridement of the proximal scaphoid pole, leaving the local ligaments as intact as possible. The proximal pole is substituted by a pyrolitic carbon implant, which has an ovoid shape and fits well into this position. We present the technique and the results of 23 of Prof. Christophe Mathoulin’s patients treated between 1998 and 2007 with 21 good results and only one palmar implant dislocation. Even though good results have been already published in the literature, these results seem closely related to the degree of instability, created by the ligament damage in the scapho-lunate area.

This treatment is therefore a salvage procedure more indicated in elderly people than in young people. On the other hand, it can be a simple and convenient waiting therapy option in other cases.

In this key lecture, Dr. Yanni goes over arthroscopic radial styloidectomy.

In this key lecture, Dr. Yanni presents an update of arthroscopic radial styloidectomy.

In this key lecture, Dr. Schmelzer-Schmied outlines bony TFCC refixation.

In this key lecture, Dr. Luchetti outlines the arthroscopic Sauve Kapandji (SV) technique.

In this key lecture, Dr. Caloia outlines the principles of repair of acute triangular fibrocartilage complex (TFCC) tears.

In this key lecture, Dr. Slutsky provides a thorough presentation about the dorsal radiocarpal ligament.

In this lecture, Dr. Compson demonstrates the arthroscopic resection of the distal ulna.

Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.