Arthroscopic repair of peripheral triangular fibrocartilage complex (TFCC) tears is now a commonly accepted method. It provides excellent functional outcome, aided in part by the vascularity of the peripheral TFCC. Currently described repairs of the TFCC require subcutaneous suture knots to be used on the ulnar aspect of the wrist to secure the repair.1–15 Traditionally the apposition of tissue and the strength of the resulting repair relied on the tying of suture, which has been reported as a potential “weak link” and a point of early failure by suture breakage at the knot.16–21 In our experience, the existence of this suture material has been a common cause of complaints among our patients in the postoperative period. Arthroscopic knots are difficult to master, they are time consuming, and most importantly, they are very bulky, which may lead to excessive foreign-body tissue reaction and knot impingement and ultimately may compromise the repair. Knots tied through the mini open incision are not as difficult technically but may lead to similar problems of bulkiness.16,17 A technology, suture welding, has been introduced that uses ultrasonic energy to weld monofilament suture together in a low-profile loop (Axya Weld; Axya Medical Inc., Beverly, MA), which eliminates the need for knot tying. This is accomplished with a fixation system (Axya Fixation System, Axya Medical Inc.) that uses ultrasonic energy in a small probelike instrument to compress the 2 limbs of the suture and weld them together. The bonding between the 2 ends of the sutures is produced by a 70-kHz ultrasonic vibration that bonds polymers by localized heating with no thermal damage to the surrounding tissues, because the energy used to perform the welding is contained within the confines of the welding sleeve. The tensile properties of the welded monofilament suture loops are superior to those of knotted monofilament suture.18 This report presents a method of arthroscopic repair for peripheral TFCC tears of Palmer type IB22 that avoids the use of suture knots, thus potentially eliminating any discomfort on the ulnar side of the wrist in the postoperative period.
Author: Alejandro Badia, MD and Alexis Jiménez, MD
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