American Association for Hand Surgery

AAHS Home AAHS Home Past & Future Meetings Past & Future Meetings
Facebook    Twitter

Back to 2026 ePosters

Biomechanical Comparison of Two Arthroscopic Transosseous Techniques for Foveal Repair of TFCC Tears: A Cadaveric Study
Kyeong Eon Kim, M.D.1, Ji-Sup Kim, M.D., Ph.D.1, YuSeoung Lee, M.D.1, Il Hyun Koh, M.D., Ph.D.2; YunRak Choi, M.D., Ph.D.2
(1)Ewha Womans University Seoul Hospital, Seoul, Seoul, Korea, Republic of (South), (2)Yonsei University College of Medicine, Seoul, Seoul, Korea, Republic of (South)

Introduction

Triangular fibrocartilage complex (TFCC) foveal injuries are a primary cause of distal radioulnar joint (DRUJ) instability, frequently leading to ulnar-sided wrist pain and functional impairment. Arthroscopic transosseous repair techniques are increasingly utilized due to their minimally invasive nature and preservation of surrounding structures. Among these, both one-tunnel and two-tunnel approaches have shown favorable clinical outcomes. However, no prior studies have directly compared their biomechanical performance. This study aimed to compare the initial fixation strength and failure characteristics of these two arthroscopic transosseous techniques for foveal TFCC repair using a cadaveric model.

Material & Methods

Eighteen fresh-frozen upper extremities from nine matched cadaveric pairs were randomly assigned to either the one-tunnel or two-tunnel arthroscopic transosseous repair group. Standardized foveal TFCC tears were arthroscopically created and repaired by a single experienced surgeon. Biomechanical testing was performed using a custom-designed jig with controlled forearm rotation and an Instron testing device. Load to create a 2-mm gap across the repair site was measured in 60° supination, neutral, and 60° pronation. Subsequently, specimens were loaded to failure in pronation. Failure mode was determined visually and arthroscopically, categorized as suture cut-out through the TFCC, bone tunnel fracture, or anchor pullout.

Results

In the pronated position, the mean load at 2-mm gap formation was 21.9 ± 12.7 N in the one-tunnel group and 25.1 ± 11.3 N in the two-tunnel group (p = 0.582). In neutral, it was 16.7 ± 5.0 N versus 17.6 ± 5.0 N (p = 0.703), and in supination, 15.6 ± 4.1 N versus 20.9 ± 8.1 N (p = 0.108). Mean load to failure was 206.2 ± 70.6 N (one-tunnel) and 239.7 ± 62.4 N (two-tunnel) (p = 0.302). No statistically significant differences were observed. Most failures occurred at the TFCC-suture junction. Anchor pullout occurred in three one-tunnel cases, while two-tunnel repairs had two fractures at the distal ulna.

Conclusion

This cadaveric biomechanical study demonstrates that both one-tunnel and two-tunnel arthroscopic transosseous techniques offer comparable initial fixation strength for TFCC foveal repair. The choice of technique may be based on surgeon preference, anatomical considerations, or technical feasibility. Further studies are warranted to assess long-term outcomes and healing characteristics.
Back to 2026 ePosters