Surgical Management of Triangular Fibrocartilage Complex Lesions: A Review of Outcomes

Abstract

Triangular fibrocartilage complex (TFCC) lesions of the wrist are primarily managed nonsurgically. Patients with persistent pain and/or instability may elect to undergo surgery (debridement, open repair, or arthroscopic repair). The current literature is unclear as to the preferred surgical technique. The purpose of this study was to review the literature and determine whether any surgical procedure was superior to others in the surgical management of TFCC lesions. Methods: We performed a thorough literature review of PubMed and EMBASE databases for all articles on surgical management of TFCC lesions. Outcomes of interest included the Disabilities of the Arm, Shoulder, and Hand scores, pain visual analog scale, modified Mayo wrist scores, grip strength, and range of motion. Results: We screened 1,762 articles and included 43 studies, for a total of 1,261 wrists. Disabilities of the Arm, Shoulder, and Hand scores were 15.4 (n ¼ 410), 24.1 (n ¼ 63), and 17.6 (n ¼ 72), in the arthroscopic repair, open repair, and debridement groups, respectively. Visual analog scale pain scores were 2.4 (n ¼ 289), 1.7 (n ¼ 60), and 2.8 (n ¼ 120), respectively. Modified Mayo wrist scores were 84 (n ¼ 299), 80 (n ¼ 154), and 88.6 (n ¼ 118), respectively. Grip strength was 83.4% (n ¼ 494), 82.9% (n ¼ 94), and 92% (n ¼ 80) of the contralateral hand, respectively. Finally, range of motion flexion-extension was 137 (n ¼ 309), 133 (n ¼ 107), and 130 (n ¼ 57), and pronation-supination was 161 (n ¼ 264), 153 (n ¼ 68), and 167 (n ¼ 57), respectively. Conclusions: Overall, patients had improvement regardless of the surgical technique employed, as measured by patient-reported and functional outcomes. According to this literature review, there is insufficient evidence to claim superiority of one surgical technique over others; treatment should be tailored to the specific lesion type. We have laid the groundwork for future prospective trials comparing surgical techniques for the management of TFCC lesions. Type of study/level of evidence: Therapeutic IV.

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

“…Recent reviews on surgical management of TFCC injuries observed that both open and arthroscopic repair techniques achieved improvement in patient-reported and functional outcomes, and there was no evidence of one technique being superior to another. 3,16,17 Nakamura et al also found that both open and arthroscopic transosseous repair techniques were reliable and successful in treating foveal detachments of the TFCC. 15 Although they reported better overall outcomes in the group that underwent arthroscopic repair compared with open repair, it should be noted that there was a significant discrepancy in their sample sizes-733 patients in arthroscopic repair group and 92 in the open repair group.…”

“…However, to date, despite the various techniques that have been described, there is still no clear consensus as to which technique provides the most optimum results. 3,16,17 Therefore, it was the aim of this study to systematically review the current literature and examine the functional and clinical outcomes as well as complications of surgical repair techniques for traumatic Palmer Type 1B TFCC tears.…”

An All-Arthroscopic Technique of Repairing Foveal Tears of the Triangular Fibrocartilage Complex Using a Bone Anchor–Repair Made Simple

“…23 The repair can be open or arthroscopic, and whereas some authors lean on the side of the arthroscopic approach because of less soft tissue unravelling, better visualization, and increased accuracy of diagnosis, there is still no clear consensus on which approach is superior as both produce equally good outcomes. [7][8][9] The mode of repair, in general, is either by creating trans osseous tunnels or using bone anchors, and there are indeed multiple well-described technique papers whose review of overall outcomes shows equally satisfactory results for both methods. 12 Then why do we have to create one more technique for repairing foveal tears using bone anchors when there are already so many techniques out there?…”

“…In case of acute presentation or failed conservative management, surgery with the aim of reattaching the TFCC to the foveal insertion site is needed 23 . The repair can be open or arthroscopic, and whereas some authors lean on the side of the arthroscopic approach because of less soft tissue unravelling, better visualization, and increased accuracy of diagnosis, there is still no clear consensus on which approach is superior as both produce equally good outcomes 7-9 . The mode of repair, in general, is either by creating trans osseous tunnels or using bone anchors, and there are indeed multiple well-described technique papers whose review of overall outcomes shows equally satisfactory results for both methods 12 .…”

“…The method of the repairs remains either by using trans osseous tunnels or bone anchors. So, which provides better outcomes—open or arthroscopic, trans osseous bone tunnels or bone anchors? 7-9 A paper by Luchetti et al has stated that though both open and arthroscopic approaches are of great value to repair and subsequent stability, the subjective outcomes of the arthroscopic approach surpass that of the open in terms of lesser soft tissue trauma, increased visibility, and diagnostic accuracy 10 . Nakamura and colleagues have stated that both open and arthroscopic trans osseous techniques are equally reliable and can treat foveal avulsions successfully 11 .…”