Patient selection considerations for AADC deficiency gene therapy.

Disruption of the foveal attachment of the triangular fibrocartilage complex (TFCC) is a well-recognized cause of distal radioulnar joint (DRUJ) instability and may lead to progressive joint degeneration and ulnar-sided wrist pain. Multiple surgical techniques have been developed to address foveal TFCC tears, including inside-out, outside-in, all-inside arthroscopic, and open approaches. Among these, arthroscopic transosseous suture repair has gained increasing popularity due to its technical simplicity, favorable clinical outcomes, and ability to restore foveal tension with minimal soft tissue disruption. Biomechanical studies have demonstrated that arthroscopic transosseous repair provides comparable or superior stability to open techniques, with the added advantages of reduced morbidity and a lower complication profile. Various methods have been described for creating bone tunnels to facilitate foveal repair, including dual Kirschner-wire (K-wire) holes, small-caliber multiple tunnels (2 mm), and single large tunnels (3–4 mm). However, significant variability exists in the literature regarding the ideal starting point for drilling, tunnel angulation relative to the ulnar shaft, and the arthroscopic positioning of the drill guide tip over the articular disc of the TFCC. This heterogeneity likely reflects differences in tunnel geometry and suture passage strategies across techniques.