Using standard wrist arthroscopy portals and setup, type 1B tears of the TFCC are repaired back to their anatomic insertion on the bone. Using a specialized Micro SutureLasso™ suture passer, a 2-0 FiberWire® suture is passed through the TFCC and a mattress stitch is created. The TFCC kit is then used to place a knotless 2.5 mm PushLock anchor into the base of the ulna. The sutures are tightened, bringing both the superficial and deep fibers of the TFCC back to their insertion site on the bone. The knotless anchor is inserted and final fixation of the TFCC back to the bone is achieved.

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A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

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Visão geral e abrangente do portfólio de produtos de cada segmento.

Catálogos

Descripción general y completa sobre la cartera de productos de cada segmento. 

Catalogs

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

The Triangular Fibrocartilage (TFCC) Ulnar Tunnel Repair technique provides a reliable and reproducible option to treat peripheral ulnar tears of the articular disk. By repairing both the superficial and deep layers (ligamentum subcruetum) of the articular disk down to bone, this technique recreates an anatomic TFCC insertion. FiberStick™ or FiberWire® provides a strong and permanent suture repair of the articular disk. The 2.5 mm Mini PushLock® provides the final knotless, no-profile fixation.

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

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Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

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Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

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Surgical Technique Guides

TFCC Ulnar Tunnel Repair

Edward L. Birdsong, MD, (Pittsburgh, PA) performs a TFCC repair back to bone arthroscopically using the Knee Scorpion™ suture passer and ulnar tunnel technique.

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A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

TFCC Repair to Fovea Using Knee Scorpion™ Suture Passer

So we've marked out the Lister's tubercle, the three four portal. We've marked the ECU tendon, and over here is a six view portal. So after we do an initial survey of the joint from radial to ulnar identifying the triangular fibrocartilage which is right there in front of you and the tear in the periphery. So when there's a tear in the triangle of Fibrocartilage, a couple of things are important to note that you can get beneath the cartilage, like my probe that you see here is completely beneath the triangular fibrocartilage. And you've lost a normal trampoline effect because it's no longer attached peripherally. So the next thing would be to make the six view portal so we can read the edges of the triangular fibrocartilage and remove any of the synovium that may be in our way in the Foveal area. We'll load the Scorpion with 200 FiberWire. So there's the small NE Scorpion any of you that do shoulder arthroscopy for rotator cuffs? This will be a very familiar procedure for you. You're going to get underneath. There's plenty of room for this knee Scorpion in here. You'll see. And we'll take a good, generous bite. I rarely have I have a lawyer. Yeah. [00:01:30] So you got the other half. There. So this is going to go around. So there's a nice horizontal mattress suture. Easily done pulling that TFC right back down to the fovea. Just like that returning the normal trampoline effect to the TFC. Now that we have our SutureCast, we just pull them aside and then we're going to use the. I use the Slam guide to pass the K-wires. So we're going to put the tip through the same portal right into the Foveal area. And you can feel that there it is. You can feel I am on bone. And we'll slide this up. To. The ulna. She can feel. Then we'll make another incision on the skin. So we can pass our. [00:02:44] Okay. So now you see, this is. Just a couple of centimeters is all you really need for this. [00:02:57] I No. That's okay. No, I like that. That's perfect. You don't need to squeeze. Yeah. Pass the guidewire. So now we're going to drill with a cannulated drill over our guidewire. What did you talking about, Kevin? Okay, so next step is very important. And what we're going to do is we're going to take this suture, retriever, pass it right up in this canal and grab those sutures. And it's important because you can easily lose this little drill hole if you don't have some exposure. So we're going to put a little retractor in here. Beautiful. [00:03:45] Okay. So then we can. Remove the drill in the guidewire. Okay. So there is your SutureLoc retriever in place the hook to grasp the sutures. I'm going to pull them one at a time. It's best if you can get both at the same time. That's ideal, but it's not a problem if you only pull one at a time. Yeah, just like that. The Scorpion placed horizontal mattress and the sutures now are coming right down to the fovea. So that's reconstructing the lateral side, the peripheral tear side of the TFC. And that will give you a nice trampoline effect. Okay. So here we are with no tension. And then when we pull tension on trampoline effect is restored. Next step is to anchor the sutures. We'll use a Knotless PushLock Arthrex anchor. And we're just going to put that just proximal to our previous hole. So we'll load the suture on the anchor. Get that out of our way. Go ahead and drill the hole for the two five PushLock. Ibalance. Suturecast. All right. Tensioning is perfect. Pushlock is now. Applied. Cut the excess suture. No suture. Knots. Nothing palpable on the ulnar border of the ulnar. Proximally. And there's our repair. Just like that.

Gustavo Mantovani, MD, (San Paulo, Brazil) presents the TFCC repair technique which aids in the repair of both volar and dorsal components of the TFCC to the distal ulna using a knotless Mini PushLock® anchor. FiberWire® suture is passed both volarly and dorsally through the TFCC and secured to the distal ulna without using a bone tunnel.

TFCC Repair Without Tunnels

Just proximal to the bump of the ulnar head. You're going to make a small incision just one centimeter with this small clamp. A mosquito clamp is filling the Bone Valley. We will feel the contour of the the owner head, and we go virtually to the ulnar styloid, just close to the bone until we reach. Until we reach the joint. Let's start the suture of the volar band here with the needle. We go into the same about the same way we did with the clamp. We are trying to to grab one thick part of the ligament in the dorsal aspect. Okay. So let's take the first. Part of the suture here. And then without removing all the needle we just going back a little while and going. Going up again. So here we have the first lasso grabbing the volar aspect of the tfcc. It's a simple lasso coming from below the tfcc. Now we're going to do the same with a dorsal. So the styloid is here. We follow it to the styloid, and we feel the end of the bone and try to reach our clamp Inside the joint. So this is a technical pier to have enough wire to get out of the skin here. Okay. We have the volar aspect. The volar bundle grabbed. Here is the lasso. Here are the wires. They're coming down by the volar aspect of the styloid. So they are volar to the styloid and going down here. Now we go to the dorsal bundle. So same way with the needle. Now more dorsally grabbing from here. First part. Now we go. Now just a little bit down and up again. That's fine. Sorry. And here we have the other lasso in the dorsal aspect. So let's go again to retrieve it by. The ulnar portal. Now we go in the dorsal direction. So dorsally dorsally to the styloid. Okay. So again I have only one. So let's. Second one. So here we have the dorsal bundle as well. So first lasso, Fuller second lasso. I cannot even see it. But it's dorsally here. And then we go straight to suture it with an anchor. So both are here. With this we make all dorsal and volar bundle just against the fovea attachment. So both knots make it the central portion to the fovea. So let's do it now in the right spot. So now we are exactly in the neck of the una, just in the middle of the styloid line. Okay. Can you see the the hole inside? Good. Okay. No knots. So here we have the knot. Firmly attach it. And the foveal aspect. The foveal attachment of the FiberTak.

Steven S. Shin, MD, (Los Angeles, CA) demonstrates an open triangular fibrocartilage complex (TFCC) repair using FiberWire® sutures and a Mini PushLock® anchor. The Mini PushLock allows for a knotless, zero-profile repair down to the ulna.

Open TFCC Repair

My name is Doctor Stephen Shin. I'm a hand surgeon with the Kerlan-jobe Orthopedic Clinic in Los Angeles. I'm here today to demonstrate the open repair of the Tfcc. Here we have a right wrist. First, I'll perform a simple diagnostic arthroscopy using two portals. The first portal is A34 portal right here, just distal to the Lister's tubercle. The second portal is the six R portal. Just a radial to the tendon. We'll just mark our portals right now. Then using a number 11 blade, make my longitudinal incision. And then use a mosquito clamp to dissect down to the dorsal wrist capsule and then pop right into the joint, which I've just done. Now we'll do a simple diagnostic arthroscopy. We're starting here radially at the radiocarpal joint, we see our volar radiocarpal ligaments. We'll now move only. Here's our scapholunate ligament. And here is our articular disk of the triangular fibrocartilage complex, our tfcc. So we'll go ahead and now insert the cannula. And while I'm holding the cannula we'll remove the trocar. So here is the cannula in place. And as an option you can use this small wrist cannula for your tfcc repairs. In this case I'll remove the cannula. I'll insert a probe at this time just to evaluate the articular disk. Here's our tfcc here. We'll now do a trampoline test with our probe. Not bad. No obvious central tear. And now I'll stick the end of the probe peripherally underneath the tfcc. And actually, she does have a peripheral tear of the articular disc. So you can see the increased laxity here as I'm kind of pushing up on the disc. So we finished the diagnostic arthroscopy. And now we'll proceed to the open repair of the tfcc peripheral tear. Proceed to make an incision right over the ulnar styloid and head just ulnar to the ECU tendon. Go ahead and retract our tissues. We'll continue with our incision through the retinaculum. Obviously you want to be careful of the dorsal under sensory branch. And now we'll just proceed incising over the ulna into the capsule. We've dissected down to the ulnar head, and Styloid performed our capsulotomy. And here is our peripheral tear of the tfcc. I have a two or FiberWire suture that I'll now pass through the tfcc. Will be performing a horizontal mattress stitch in the periphery of the tfcc. This will pull the tfcc down nicely back down to the ulnar foveal region. Each strand of the FiberWire suture will pass around the ulnar styloid as such, and then we'll use a PushLock anchor to dunk the suture ends into the distal ulna. Here's our drill for our 2.5mm PushLock anchor, just about a centimeter or so proximal to the ulnar fovea. Drill all the way down to the stop. We'll take our suture ends here that are passing through the tfcc. We'll cut the needle off and then pass the two limbs of the suture through the eyelet in the PushLock anchor. We've now passed the two limbs of the FiberWire suture through the eyelet of the PushLock anchor. We'll now place the eyelet into the Into the hole while pulling tension on the two limbs of the suture with the anchor down to the outer cortex of the bone. We'll proceed to insert the anchor. Into the ulna. Once that's done. We'll remove the handle. And assess the strength of the sutures, which is good. It's not going anywhere. And then remove the suture. Limbs. I repaired the peripheral tear of the tfcc using the FiberWire sutures and a PushLock anchor. You can see that it's nice and taut. I'll now proceed to repair the most peripheral edge of the tfcc, using the suture through adjacent capsule and Ostium a place at least 2 or 3 sutures to bring the peripheral edge down again on this side, grabbing some of that capsule through the most peripheral edge. And we'll just look at it again. As you can see, a very taut repair of the tfcc. We'll need to also perform a tight capsular closure, which is very important as well. The Tfcc is a complex of different structures at the ulnar side of the wrist, not just the articular disc. So it is important to make sure that all of these structures are closed tightly up here. I will more distantly grab both the retinaculum and the capsule dorsally. Here's our retinaculum here, and then we just proceed to place a few more sutures to close up the deeper layer. And then you can just close the skin and your standard fashion. I usually use an absorbable suture and a subcuticular fashion, and the incision heals very nicely. Postoperatively. I'll mobilize the patient in a sugar tong splint for 7 to 10 days at the first post-operative visit. I'll remove the splint and convert them to a Munster type cast. I'll continue mobilization for another three weeks for a total of four weeks of post-operative immobilization at four weeks post-operative. We'll begin therapy. Therapy will continue for approximately two months to regain range of motion and strength by about three months or so. The patient is back to their normal activities.

The Triangular Fibrocartilage Complex (TFCC) Ulnar Tunnel Repair technique provides a reliable and reproducible option to treat peripheral ulnar tears of the articular disk. By repairing both the superficial and deep layers (ligamentum subcruentum) of the articular disk down to bone, this technique recreates an anatomic TFCC insertion. FiberStickTM or FiberWire® provides a strong and permanent mattress suture repair of the articular disk, and the 2.5 mm Mini PushLock® provides the final knotless, no-profile fixation.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

TFCC Ulnar Tunnel Repair Technique

This technique describes the Arthrex tfcc ulnar tunnel knotless repair back to bone. The three, four, four, five and six are wrist portals are created and the scope is advanced to obtain. Visualization of the Tfcc aiming guide can be placed through the six portal to help create the ulnar tunnel. The K-wires is advanced through the Tfcc. The three millimeter Cannulated drill is then advanced over the wire and through the foveal cortex. The loaded micro SutureLasso with FiberStick is then advanced through the tfcc, just peripheral to the tear. Reinsert the straight SutureLasso loaded with nitinol wire and retrieve the FiberStick and the nitinol. Wire out the three four portal. The FiberStick is then threaded through the nitinol loop and pulled through the ulnar tunnel. The bone is prepared for the mini PushLock anchor. The FiberStick is threaded through the eyelet of the mini PushLock anchor. The anchor suture construct is then tensioned and deployed to create a low profile knotless repair.

A new technique, presented by Dr. Richard Howard (St. Louis, MO), describes a knotless arthroscopic repair of foveal TFCC tears through an ulnar tunnel. Using Micro SutureLassos, Fiberwire suture is passed arthroscopically through the torn TFCC. The sutures are then tensioned through an ulnar drill tunnel and the TFCC is reapproximated back to its ulnar attachment. Pushlock anchors are used to provide low profile knotless fixation of the sutures in the ulna. The final construct results in a stable knotless repair of the TFCC back to bone using a reproducible and low profile repair.

Arthroscopic Foveal Reattachment of TFCC through an Ulnar Tunnel

So we do a TFC repair. We want to do it through A34 viewing portal. So this is a central radial sided tear. And there is your pre styloid recess. A couple of reference points I need to make is I need to know where the tip of the ulnar styloid is. And I need to know the anterior and posterior dimensions of the ulna. I want to shoot a pin at a 45 degree angle coming up into this foveal area. You can do that with a slam guide. You can do it freehand. So I just poke this in. So that's kind of pretty close to where we want to be. So we'll leave that in. We're just going to make an incision right over the wire. And when I when I do that, I'll just palpate the bone and make sure that I'm I'm centered. Then we're going to drill over the wire with a three millimeter cannulated drill. When we pass these sutures, the first pass, we're going to just take a 200 FiberStick and bend it over the tip like you see here. And as it penetrates, it will pop through the TFC on a real unstable TFC. I can kind of hold the TFC down and then penetrate with this parser. And this will be my most medial stitch. And it looks like it might be too medial. But you got to remember I'm coming in at about a 45 degree angle. So notice how I got to push down on the cartilage. It's a tight space, so it's hard to pass point. But you can spin this suture and it'll spiral itself above the TFC like a screw. And it leaves a nice big loop there. And then I can just pull back and that loop will stay behind. So I'm going to come a little more vertical this time and get this bite back here further. So now I'm a little more peripheral here. And I'm going to insert this loop and I'm going to retrieve both of these together. The advantage of coming out both is that I'm not going to get any soft tissue trap between the suture and my snare. So we come out with this, you can get fancy and thread it inside the joint. I do that sometimes if it's easy and fast, but I'll go ahead and load this outside. And then we're going to retrieve this down the cannula. Just putting a large mattress suture over the top of the tfcc. And again I'm docking that down into that three millimeter tunnel. And I'll clip that with a hemostat and toss it to the side. Then we'll load another FiberStick and I will make a cruciate right over the top. And again, I can do that little spin maneuver to push a bunch of suture into the joint. So my next one needs to go right over here to kind of form that cruciate pattern. So there's my fourth pass. And I want to feed that retriever there and grab these two and bring them outside the joint. So suture goes through the night and all loop retrieve that suture down. And now we have the mattress. Really stout repair pulling down into that tunnel there. It's stable. And when you have a patient who has some mild instability or even dramatic instability, you'll suck these sutures down. You can reexamine the patient, and it's impressively stable. So what we do now is we independently load these onto a PushLock anchor. It's very helpful to turn the water off when you're doing this step. I aim these up slightly. And remember, this is a stop drill. We can we can see our tunnel. We're about half centimeter from where these are exiting the bone, maybe a centimeter. And then we're going to load these onto the mini PushLock. It's kind of a push pull. Make sure we've got that really well seated. All right. Mallet. And you can over bury these things. You just seed it to the cortex. And I usually just cut these suture tales with a knife. Then we're going to load this onto a separate PushLock. So we've got two different anchors. Again get the tip kind of seated a little push pull. Make sure you got tension watching through the scope. Here we have two anchors. You can see they're coming down from this tunnel about a centimeter above into the ulna. You can see that these are really secured in there. Now, remember how I could lift that up before this is docked into that tunnel? Now, this critique, this a little this suture could have been a little tighter, but it's still docked down there. This one's better. But you see how they're crossing over. And I've got a good I can't lift that up anymore. So the post-op protocol would be that this patient goes home in a sugar tong splint in mid ProEAS supination, So thumb pointed at their nose. We have them then come back to the office in roughly a week. At that time, the therapist will make them a monster type splint, which allows them then to still flex and extend their elbow a little bit. But it blocks any pronation supination, and they stay in that for six weeks, and then they come out of the brace and start a slow, progressive program of motion, usually at six weeks after that. So they'd be three months post-op. Then we'll let them actually do strengthening and loading for somebody who's going to do weight bearing activities. I don't really let them go back to something like gymnastics, cheerleading, weightlifting for four months and have not had any issues with recurrence on that protocol.

German (Deutsch) - de

Arthroskopische knotenlose Refixierung des TFCC

2-0 FiberStick, 2-0 FiberWire, 50" (blue) one end stiffened, 12"

FiberStick #2-0, mit 30.0 cm gesteiftem Ende, steril

Mädchen-Fänger-Netzschlauch, XL, steril, SU

Schaumstoffpolster für Handgelenk-Fixation, steril, SU

Almohadilla para mano para torre de muñeca

ALMOFADA DE MAO PARA TORRE DE TRACAO DE PUNHO

Counter Traction Pad for Wrist Tower

Schaumstoffauflage für Oberarmhalter, VE5, unsteril

Arthroscopic Knotless TFCC Repair Using the PushLock^® Anchor

Educational Resources and Products

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Surgical Technique Videos (4)

TFCC Repair to Fovea Using Knee Scorpion™ Suture Passer

TFCC Repair Without Tunnels

Open TFCC Repair

Arthroscopic Foveal Reattachment of TFCC through an Ulnar Tunnel

Surgical Technique Animations (1)

TFCC Ulnar Tunnel Repair Technique

Surgical Technique Guides (2)

TFCC Ulnar Tunnel Repair

Arthroskopische knotenlose Refixierung des TFCC

Catalogs (1)

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Related Products (9)

AR-8825P

AR-8825BC

AR-1322DSC

AR-8704

AR-8705

AR-8825CP

AR-8701

AR-8702

AR-8703

Optional Accessories (8)

AR-7222

AR-1616-X

AR-1616-S

AR-1616-M

AR-1616-L

AR-1614

AR-1617

AR-1615

Arthroscopic Knotless TFCC Repair Using the PushLock® Anchor

Educational Resources and Products

All Resources

All Products

Videos

Documents

Languages

Surgical Technique Videos (4)

TFCC Repair to Fovea Using Knee Scorpion™ Suture Passer

TFCC Repair Without Tunnels

Open TFCC Repair

Arthroscopic Foveal Reattachment of TFCC through an Ulnar Tunnel

Surgical Technique Animations (1)

TFCC Ulnar Tunnel Repair Technique

Surgical Technique Guides (2)

TFCC Ulnar Tunnel Repair

Arthroskopische knotenlose Refixierung des TFCC

Catalogs (1)

Hand, Wrist, and Elbow - Next Generation in Repair and Reconstruction

Related Products (9)

Related Products (9)

AR-8825P

AR-8825BC

AR-1322DSC

AR-8704

AR-8705

AR-8825CP

AR-8701

AR-8702

AR-8703

Optional Accessories (8)

Optional Accessories (8)

AR-7222

AR-1616-X

AR-1616-S

AR-1616-M

AR-1616-L

AR-1614

AR-1617

AR-1615

Arthroscopic Knotless TFCC Repair Using the PushLock^® Anchor