Arthroscopic-Assisted Suture Tape-Reinforced Triangular Fibrocartilage Complex Repair and Distal Radioulnar Ligament Augmentation Using a Modified Adams-Berger Technique.

Abstract

Distal radioulnar joint instability secondary to triangular fibrocartilage complex (TFCC) injury remains a major challenge in wrist surgery. Traditional tendon graft-based reconstruction techniques, such as the Adams-Berger procedure, though effective, require extensive soft tissue dissection and tendon harvesting, resulting in significant surgical morbidity. Meanwhile, isolated arthroscopic TFCC repairs often fail to achieve durable stabilization in chronic or degenerative cases due to poor tissue quality and insufficient fixation strength. To overcome these limitations, we present a modified minimally invasive technique that combines arthroscopic TFCC repair using FiberTape with an anatomic augmentation of the distal radioulnar ligament based on the Adams-Berger concept. A small volar incision is made over the distal radioulnar joint to create a bone tunnel at the radial insertion of the TFCC, through which FiberTape is introduced and routed along the volar and dorsal aspects of the joint capsule to the ulnar side. Under direct arthroscopic visualization, a suture lasso is used to shuttle the FiberTape through the TFCC and across its anatomic attachment at the ulnar fovea. Final tensioning and knot tying are performed at the ulnar tunnel outlet, forming a circumferential internal brace that anatomically replicates the deep distal radioulnar ligament configuration. This technique provides immediate biomechanical stability without the need for tendon harvesting, minimizes soft tissue disruption, and enables early postoperative mobilization. It offers a reproducible, low-morbidity, and anatomically faithful method for distal radioulnar joint augmentation.