Ulnocarpal Arthroscopy and Distal Radioulnar Arthroscopy

he triangular fibrocartilage complex (TFCC) is the major stabilizer of the distal radioulnar joint. TFCC disorders may have traumatic or degenerative etiology. TFCC is most often lacerated at its ulnar periphery. According to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may also fracture, producing different subtypes of type 1B tears. Treatment options are variable, depending on the tear’s features. Atzei introduced in 2011 a novel treatment-oriented classification subdividing 1B-type lesions into five different classes according to the finding of special radiocarpal arthroscopic tests and distal radioulnar joint arthroscopy. In this chapter, the all-inside arthroscopic repair technique for Atzei class 2 and 3 TFCC foveal lesions is described. In chronic irreparable TFCC tears with clinical DRUJ instability in which the articular cartilage is in good condition, ligament reconstruction with tendon graft is the treatment of choice. It is also the preferred treatment in cases of previous failed repair surgeries in patients with clinical DRUJ instability. In this chapter, the All-Arthroscopic technique for TFCC ligamentoplasty based on the anatomical insertions of the triangular fibrocartilage in the ulnar fovea and in the dorsal and volar corners of the sigmoid notch is also described. Ulnocarpal impaction syndrome is a common cause of pain and functional loss. The treatment is based on decompressing the ulnar head by shortening osteotomies or partial resection. Wafer procedure reduces ulnocarpal pressure without implants. In this chapter, arthroscopic wafer technique is described.