1. Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex 
Wei-Jen Chen, M.D. 
Arthroscopy Techniques 
Volume 6, Issue 1, Pages e57-e64 (February 2017)
DOI: /j.eats
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

2. Fig 1
Illustration in the right wrist. (A) A 3-cm skin incision (red dash line) from the ulnar styloid tip extending proximally; the orange arrow points at the 3-4 portal and the white arrow points at the 6R portal. (B) The retinaculum (green arrow) between the extensor carpi ulnaris (ECU) tendon and the flexor carpi ulnaris tendon is incised; the red star indicates the ulnar styloid tip. (C) The ECU tendon sheath (blue arrow, grasped by the forceps) is opened; the yellow arrow indicates the ECU tendon. (D) The volar capsule (red arrow) of the distal radioulnar joint and ulnocarpal joint is exposed; the red triangle indicates the direct foveal portal and the red star indicates the ulnar styloid tip.
Arthroscopy Techniques 2017 6, e57-e64DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

3. Fig 2
Illustration in the right wrist. (A) A shaver or curette can access the fovea through the prestyloid recess (green dot) while viewing from the 3-4 portal. The precise location of refreshing could be verified by fluoroscopy (A, B). (B) Alternatively, the foveal refreshing could be directly visualized from the distal radioulnar joint (DRUJ) portal or instrument from the direct foveal portal. The arthroscopic view shows the DRUJ arthroscopic view of the shaver over fovea (yellow dot) through the direct foveal portal.
Arthroscopy Techniques 2017 6, e57-e64DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

4. Fig 3
Illustration in the right wrist. (A) The ulnar bone tunnel is created with a 1.6-mm wire inserted approximately 2.5 cm proximal to the ulnar styloid tip. The exit point monitored under intraoperative fluoroscopy is located at the radial border of the fovea (purple arrow). (B) Alternatively, an aiming device could be employed with the device's aiming tip (white arrow) located 3-4 mm radial to the prestyloid recess (orange arrow); the green star indicates the triangular fibrocartilage complex (TFCC) disk. (C) One 2-0 Polysorb and one 2-0 Maxon sutures are loaded into a 16G needle and folded in half at the needle tip, forming 2 suture loops, when passing through the bone tunnel and penetrating the TFCC. (D) Using a probe pressing the floppy TFCC will facilitate TFCC penetration; the orange arrow points at the prestyloid recess. (E, F) A grasper from the 6R portal is used to retrieve both suture loops once the needle penetrates through the TFCC. (G) Two suture loops retrieved from the 6R portals are divided into 4 suture strands.
Arthroscopy Techniques 2017 6, e57-e64DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

5. Fig 4
Illustration in the right wrist. (A) A 3-0 nylon suture is loaded in a 22G needle as a suture lasso. (B) The 4 distal suture limbs are retrieved separately from the dorsal and volar edge of the ulnar styloid base via the prestyloid recess (orange arrow), ulnotriquetral ligament (white arrow), and extensor carpi ulnaris (ECU) subsheath; the green star indicates the triangular fibrocartilage complex disk. (C) The illustration of 4 suture arrangements is shown; the red star indicates the ulnar styloid process; the green and purple lines indicate the sutures; the forceps points at the ECU subsheath; white arrow points at the ulnotriquetral ligament. (D) The final suture construct seen from the 3-4 portal and the ulnar incision; the red star indicates the ulnar styloid process; the white arrow points at the ulnotriquetral ligament; the orange arrow points at the prestyloid recess. The green star illustrates the spatial orientation of the arthroscopic photo.
Arthroscopy Techniques 2017 6, e57-e64DOI: ( /j.eats )
Copyright © 2016 Arthroscopy Association of North America Terms and Conditions