All-Arthroscopic Knotless Suture Anchor Repair of Triangular Fibrocartilage Complex Fovea Tear by the 2-Portal Technique  Yongcheol Park, M.D.  Arthroscopy Techniques  Volume 3, Issue 6, Pages e673-e677 (December 2014) DOI: 10.1016/j.eats.2014.08.005 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) The 18-gauge needle, bent along the thumb pulp, is inserted at a point 1 cm proximal from the ulnar styloid tip. The threaded suture tail out of the needle measures about 5 cm. (B) Viewing through 3-4 portal. The needle penetrates the TFCC slightly anterior to make room for the second stitch. (C) The cannula is pushed into the 6R portal. This makes the procedure far easier. (D) The needle, which as retreated beneath the TFCC, penetrates the slightly posterior TFCC. The left suture is lying inside the 6R portal cannula, and the right suture loop should be pulled back at this time. The dotted line shows the loop of suture that was made under the TFCC, and the solid line shows the needle threaded with suture. (E) The knotless anchor is advanced through the 6R cannula to make sure that there is no obstacle. (F) The suture limbs are retrieved from the cannula through the slot, and the obturator is inserted. Arthroscopy Techniques 2014 3, e673-e677DOI: (10.1016/j.eats.2014.08.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) The guidewire is fixed to the far cortex, and the reamer creates the bone tunnel. The bone tunnel should be no more than 0.5 cm to yield stronger anchor fixation. (B) The guidewire and the threaded anchor are inside the cannula together. At this time, the arthroscope and fluoroscope should be used to observe the bone tunnel tagged with the guidewire. (C) After the guidewire is removed by the assistant, the eyelet of the anchor is inserted into the bone tunnel with the feeling of “pop” in the hand. The surgeon can feel the resistance, and the anchor does not advance on fluoroscopy, despite the soft tapping performed. Next, the suture tails are pulled to give an appropriate amount of tension to the TFCC. (D) Once the surgeon confirms the correct insertion of the anchor, the safety cap is removed. When the anchor advances to the bone tunnel with hard tapping, the marrow fat can be seen. The fat bubble sign confirms entrance into the bone tunnel. Arthroscopy Techniques 2014 3, e673-e677DOI: (10.1016/j.eats.2014.08.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 Fifty-one–year–old man. (A) Viewing through 3-4 portal. A TFCC fovea tear combined with a type IIC central tear was repaired by the all-arthroscopic 2-portal technique using knotless suture anchor. (B) The standard 3-4 portal and high 6R portal are the only portals used in repairing the TFCC. Arthroscopy Techniques 2014 3, e673-e677DOI: (10.1016/j.eats.2014.08.005) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions