All-arthroscopic Knotless Foveal TFCC Reinsertion: Prospective Outcomes and Comparative Analysis?

Foveal avulsion of the triangular fibrocartilage complex (TFCC) is a major cause of distal radioulnar joint (DRUJ) instability and ulnar-sided wrist pain. Although several arthroscopic foveal repair techniques have been described, complications related to soft tissue dissection, ulnar tunneling, and knot-related irritation remain a concern. To evaluate the clinical outcomes of an all-arthroscopic knotless foveal TFCC reinsertion technique and to compare the results with previously published repair techniques. A prospective series of 43 patients with symptomatic DRUJ instability secondary to complete foveal TFCC avulsion was analyzed. All patients underwent all-arthroscopic knotless foveal TFCC reinsertion using a suture anchor technique. Clinical evaluation included pain (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, Mayo Wrist Score (MWS), wrist range of motion, and time to return to full activity. Outcomes were assessed preoperatively and at 12-month follow-up. Statistical analysis was performed using paired Student's t-test. At 12-month follow-up, VAS pain scores improved significantly from 5.76 ± 1.41 to 1.24 ± 1.10 (p < 0.001). QuickDASH scores improved from 41.31 ± 4.70 preoperatively to 6.52 ± 5.72 at 12 months, representing a mean improvement of 34.79 points (95% CI: 33.1–37.4; p < 0.001). Wrist flexion–extension arc improved significantly from 128.79 ± 9.97 to 133.62 ± 4.98 degrees (p = 0.006), while forearm pronation and supination also showed significant improvement (78.79 ± 9.32 to 87.41 ± 4.14 degrees, p = 0.010; and 78.97 ± 8.70 to 87.93 ± 3.66 degrees, p = 0.001, respectively). The mean time to return to full activity was 4.86 ± 1.16 months. The approximate operative time was 45 to 60 minutes. Functional outcomes assessed with the MWS showed 86.04% of good or excellent results (62.79% excellent, 23.25% good). One patient (2.3%) required secondary TFCC ligament reconstruction due to recurrent DRUJ instability secondary to failure of healing in a very chronic lesion with poor tissue quality. No cases of ulnar neuritis or complex regional pain syndrome were observed. All-arthroscopic knotless foveal TFCC reinsertion provides reliable pain relief, functional improvement, and restoration of DRUJ stability with a low complication rate. Direct visualization of the foveal footprint may allow a more anatomic reinsertion by enabling precise identification of the native insertion site. In addition, dry arthroscopy with selective lavage, avoidance of ulnar tunneling, elimination of knot-related morbidity, and no need for intraoperative fluoroscopy represent relevant technical and anatomical advantages over previously described techniques. Level IV, prospective case series.