JHS - 2026-03-04 - Journal Article
Comparison of Manual Tie and Knotless Suture Anchor Techniques in Arthroscopic Transosseous Foveal Repair of the Triangular Fibrocartilage Complex.
Morisaki S, Yoshii K, Tsuchida S, Oda R, Takahashi K
Topics
Key Takeaway
In arthroscopic transosseous TFCC foveal repair, knotless suture anchor fixation was an independent predictor of favorable outcomes (Modified Mayo Wrist Score ≥80) on multivariate regression, with greater postoperative wrist flexion arc compared to manual tie technique in 70 patients.
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Summary
This study asked whether knotless suture anchor fixation produces superior outcomes versus conventional manual tie technique in arthroscopic transosseous TFCC foveal repair. Seventy patients were retrospectively reviewed with clinical endpoints including grip strength, ROM, QuickDASH, VAS, and MMWS. Univariate analysis showed no significant between-group differences in QuickDASH, VAS, or MMWS, but multivariate logistic regression identified knotless anchor technique as an independent predictor of MMWS ≥80, alongside preoperative grip strength and preoperative MMWS.
Key Limitation
The absence of randomization and the retrospective design mean that surgeon preference likely drove technique selection, introducing unmeasured confounding that multivariate regression cannot fully eliminate.
Original Abstract
PURPOSE
Arthroscopic transosseous foveal repair is a widely accepted technique for restoring distal radioulnar (DRU) joint stability in patients with triangular fibrocartilage complex (TFCC) foveal tears. The optimal method of final fixation remains controversial. This study compared postoperative outcomes between two fixation methods in transosseous suture repair: the conventional manual tie technique and the knotless suture anchor technique.
METHODS
We retrospectively reviewed 70 patients who underwent arthroscopic TFCC foveal repair procedures between April 2015 and August 2024. Thirty-three procedures were performed using the manual tie technique, and 37 procedures were performed using the knotless suture anchor technique. Clinical evaluations included grip strength; wrist range of motion; Quick Disabilities of the Arm, Shoulder and Hand score; visual analog scale for pain; and Modified Mayo Wrist Score (MMWS). Multivariate logistic regression analysis was used to identify independent predictors of favorable outcomes, defined as a postoperative MMWS ≥ 80.
RESULTS
Both techniques yielded significant postoperative improvements in grip strength, wrist motion, pain, and functional scores. Compared with the manual tie technique, the knotless anchor technique resulted in greater postoperative-wrist flexion and a larger flexion-extension arc. Although no significant differences were detected between groups in Quick Disabilities of the Arm, Shoulder and Hand score, visual analog scale score, or MMWS on univariate analysis, multivariate logistic regression identified the knotless anchor technique as an independent predictor of favorable outcomes, together with preoperative-grip strength and preoperative MMWS.
CONCLUSIONS
The manual tie technique and knotless suture anchor technique were effective for arthroscopic transosseous foveal repair of TFCC tears; however, the knotless anchor method was independently associated with better functional outcomes. These findings suggested that knotless anchor fixation may provide clinical advantages over the conventional manual tie technique.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic III.