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Relevant landmarks to navigate the suture locations for the arthroscopic triangular fibrocartilage complex foveal reattachment

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Abstract

Introduction

Key step of arthroscopic triangular fibrocartilage complex (TFCC) foveal reattachment is to suture dorsal and palmar deep components of radioulnar ligaments (RULs) to the fovea of ulnar head to ensure distal radioulnar joint stability. However, the deep components are covered and cannot be identified arthroscopically from standard radiocarpal joint view. Suturing sites described in previous studies have not been proved gas** of the deep components. The purpose of this study was to investigate our TFCC suture locations using relevant landmarks on securing the RULs’ deep components for arthroscopic TFCC foveal reattachment.

Materials and methods

Wrist arthroscopy and horizontal mattress suture was performed in 20 fresh–frozen cadaver wrists. Based on close proximity of the ulnocarpal ligaments to the palmar RUL and fovea, palmar suture location was designated at the junction between ulnolunate, ulnotriquetral ligaments and palmar border of TFCC disc, whereas dorsal suture location was at dorsal border of TFCC disc, opposite the palmar location, at same distance between prestyloid recess and palmar location. The radiocarpal and ulnocarpal joint was subsequently opened to evaluate gras** of RULs’ deep components and evaluate the relevant landmarks.

Results

Thirty-nine of 40 (97%) RULs’ deep components were successfully grasped by the sutures. With 0.98–0.99 interobserver agreement for the measurements, mean distance between sigmoid notch to suture and suture to ulnar capsule were 5.6 ± 1.1 and 4.0 ± 0.9 mm, respectively. Whereas, the dissecting point of deep component from the superficial component of the RULs was detected immediately radial to the midpoint between the sigmoid notch and the ulnar capsule (4.5 ± 0.9 mm from sigmoid notch).

Conclusions

We determined the relevant anatomical landmarks to navigate the TFCC suture locations, which reliably secure the deep components of the radioulnar ligaments for the arthroscopic TFCC foveal reattachment.

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Acknowledgements

We would like to thank Prapasri Kulalert, M.D. Lecturer of Clinical Epidemiology, Department and consultant Clinical Research Center, Faculty of Medicine, Thammasat University (Grant No. 2–23/2561) for assisting in research methodology and data analysis.

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Authors and Affiliations

  1. Hand and Microsurgery, Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99/209 Paholyothin Rd, Klong Luang, Pathumthani, 12120, Thailand

    Thanapong Waitayawinyu, Narut Sekekun, Petai Sopasilapa & Chinnakart Boonyasirikool

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  1. Thanapong Waitayawinyu
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  2. Narut Sekekun
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  3. Petai Sopasilapa
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  4. Chinnakart Boonyasirikool
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Contributions

TW was involved in conceptualization, methodology, dissection, writing—original manuscript, and project administration. NS was involved in researched literature, dissection, gaining ethical approval, and data analysis. PS was involved in dissection, data curation and analysis. CB was involved in researched literature and data curation and analysis. All the authors reviewed and edited the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Thanapong Waitayawinyu.

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Conflict of interest

All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

The study was performed in line with the principles of the Declaration of Helsinki. Ethical approval for this study was obtained from the Human Research Ethics Committee of Thammasat University (Faculty of Medicine) Number of COA 047/2561.

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Waitayawinyu, T., Sekekun, N., Sopasilapa, P. et al. Relevant landmarks to navigate the suture locations for the arthroscopic triangular fibrocartilage complex foveal reattachment. Arch Orthop Trauma Surg 143, 1707–1714 (2023). https://doi.org/10.1007/s00402-022-04600-4

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