From the Triangular Fibrocartilage to the Foveal Concept: The Historical Evolution of Triangular Fibrocartilage Complex Anatomy, Diagnosis, and Repair

This review aims to trace the historical evolution of the triangular fibrocartilage complex (TFCC), from early descriptions of wrist trauma and triangular fibrocartilage to the contemporary understanding of the foveal attachment as a critical determinant of distal radioulnar joint (DRUJ) stability.A comprehensive review of medical and historical literature was conducted, including classical medical writings, historical anatomical texts, and landmark anatomical, biomechanical, diagnostic, arthroscopic, and surgical studies.Significant contributions were analyzed chronologically and within their scientific contexts, identifying key conceptual shifts that shaped the modern understanding and treatment of TFCC pathology.The history of TFCC reflects a shift from anatomical description to functional interpretation.Early descriptions of wrist injuries gradually evolved into a more comprehensive understanding of the relevant soft-tissue anatomy.Subsequent anatomical and biomechanical advances established the TFCC as a functional complex involved in ulnocarpal load transfer and DRUJ stability.The development of classification systems provided a morphological framework for traumatic and degenerative lesions, while advances in wrist arthroscopy made it possible to directly and dynamically assess TFCC pathology.Further anatomical and histological investigations refined the understanding of the stabilizing role of the foveal attachment, shifting clinical attention from the tear site to functional instability.This shift redirected surgical treatment from debridement and peripheral suturing to anatomical foveal reattachment and reconstruction in irreparable lesions.The evolution of TFCC knowledge can be understood through three main transitional pathways: from structure to complex, from morphology to function, and from tear repair to stability restoration.The modern foveal concept represents the culmination of successive advances in anatomy, biomechanics, arthroscopy, imaging, and surgery, and provides the conceptual basis for the contemporary management of TFCC injuries and DRUJ instability.