Biomechanical Cadaveric Study of a Method for Foveal Reinsertion of the Triangular Fibrocartilage Complex Without Foveal Perforation.

Abstract

Triangular fibrocartilage complex (TFCC) injuries can compromise distal radioulnar joint (DRUJ) stability, especially when the foveal insertion is affected. Various arthroscopic and open repair techniques have been described, including bone tunnels and anchors, but no consensus exists on the optimal approach. This biomechanical study evaluates a modified foveal reinsertion technique based on Mantovani's method for Atzei class 2 lesions, which avoids foveal perforation. Twenty cryopreserved upper extremities (13 female, 7 male specimens; mean age 83 years) were tested. Radius displacement relative to the ulna was measured in 3 conditions: intact TFCC, sectioned TFCC (simulating a foveal lesion), and repaired TFCC. Tests were performed in neutral rotation, 60° pronation, and 60° supination, applying a 3 kg dorsal and volar load to simulate functional stress. Displacement was recorded using the FASTRAK 3D electromagnetic system. Results showed a significant increase in displacement after TFCC sectioning in all positions, confirming the fovea's role in stability. After repair, displacement values returned to levels comparable with the intact TFCC, with no statistically significant differences. This technique preserves the TFCC's anatomical footprint, avoids bone tunnels (reducing fracture risk and radiation exposure), and distributes forces more evenly across the insertion. It also requires no special devices, making it a cost-effective and reproducible option. This study demonstrates that the proposed technique restores DRUJ stability.