Safety analysis of all-inside arthroscopic repair of peripheral triangular fibrocartilage complex.
OBJECTIVE
The purpose of this study was to determine whether an all-inside peripheral triangular fibrocartilage complex (TFCC) repair using the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) is safe by measuring the proximity of the anchors to ulnar-sided anatomic structures.


METHODS
Eleven fresh-frozen cadaveric wrists were thawed and placed in traction. Under direct arthroscopic visualization, an all-inside arthroscopic peripheral TFCC repair was completed by placing a single FasT-Fix device in a vertical mattress fashion. The wrists were then dissected to visualize the 2 anchors. The distance between these anchors and the flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), and dorsal branch of the ulnar sensory nerve (DBUN) were measured with digital calipers and recorded.


RESULTS
The peripheral anchor averaged 4.2 mm (range, 0 to 14 mm) from the ECU tendon, 3.8 mm (range, 0 to 9 mm) from the DBUN, and 8.3 mm (range, 1 to 15 mm) from the FCU tendon. The central anchor averaged 9.6 mm (range, 2 to 15 mm) from the ECU tendon, 6.8 mm (range, 1 to 13 mm) from the DBUN, and 7.6 mm (range, 1 to 13 mm) from the FCU tendon.


CONCLUSIONS
This study exposes some safety concerns with the all-inside peripheral TFCC repair using the FasT-Fix device, which was found to reside in close proximity to the ECU, FCU, and DBUN. In multiple wrists the anchors were noted to underlie the anatomic structure that we measured, making it possible to pierce these structures with the needle before deployment of the anchor.


CONCLUSIONS
Though technically feasible, all-inside arthroscopic repair of the peripheral TFCC risks injury to the ulnar-sided anatomy.
Waterman
Scott M
SM
Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA. scott.m.waterman@us.army.mil
Slade
Dirk
D
Masini
Brendan D
BD
Owens
Brett D
BD
D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D002102:Cadaver; D004210:Dissection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012449:Safety; D053441:Suture Anchors; D013536:Suture Techniques; D013718:Tensile Strength; D051478:Triangular Fibrocartilage / Q000293:injuries / Q000601:surgery*; D014457:Ulna / Q000601:surgery; D014459:Ulnar Nerve / Q000601:surgery; D014955:Wrist Joint / Q000601:surgery*; D055815:Young Adult