Arthroscopic Repair of Combined Triangular Fibrocartilage Complex, Lunotriquetral Ligament, and Ulnocarpal Ligament Tears

The ulnocarpal ligament complex (UCLC), consisting of the ulnotriquetral, ulnolunate, and ulnocapitate ligaments, plays a pivotal role in maintaining ulnocarpal joint stability and is closely linked to the palmar radioulnar ligament (PRUL), preventing dorsal ulnar translation. Often, tears in the PRUL and UCLC coincide with lunotriquetral interosseous ligament (LTIL) tears as the result of their strong anatomical connections. Biomechanical studies have demonstrated that ulnar-shortening osteotomy enhances stability in the distal radioulnar joint, lunotriquetral joint, and UCLC by tightening the ligaments and capsules. Our technique aims to replicate the effects of ulnar-shortening osteotomy by plicating the volar triangular fibrocartilage complex (TFCC) and capsule, addressing combined TFCC, UCLC, and LTIL pathologies with a single-strand suture approach. Although surgical treatments exist for ulnotriquetral and LTIL tears, addressing concurrent PRUL or palmar TFCC tears has remained a challenge. This article presents a simple technique for managing these complex ulnar wrist pathologies.