Surgical Repair of Acute TFCC Injury

Abstract

Triangular fibrocartilage complex tears are a common source of ulnar-sided wrist pain and distal radioulnar joint instability. Symptoms recalcitrant to conservative management or injuries in high-demand athletes may indicate surgical management. Both open and arthroscopic techniques offer improvements in objective measures, patient-centered outcome scores, and return to work, but may be complicated by nerve irritation, persistent wrist instability, and pain. Recently developed knotless arthroscopic techniques are not well studied but may limit morbidity.

Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy

“…The superficial layer is attached to the ulnar styloid process, and the deep layer is attached to the ulnar fovea and extends into the ulnar collateral ligament and ulnocarpal ligament. 7 The meniscus homologue is located between the TFC and ulnar collateral ligaments as a layer of the hyaline perichondrium. The TFC is attached to the styloid process of the ulna through meniscal homologue.…”

“…The TFC is surrounded by volar and dorsal distal radioulnar ligaments that merge and divide into 2 parts: deep and superficial. The superficial layer is attached to the ulnar styloid process, and the deep layer is attached to the ulnar fovea and extends into the ulnar collateral ligament and ulnocarpal ligament 7 . The meniscus homologue is located between the TFC and ulnar collateral ligaments as a layer of the hyaline perichondrium.…”

Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review

“…Current standard of treatment for a TFCC injury in the general population begins with a period of immobilization, analgesics, and activity modification. 3 Operative treatment consisting of debridement or repair is then considered for individuals with symptoms refractory to initial conservative management. 9 Although most patients' symptoms will resolve with nonoperative treatment, more than one-third of patients with a TFCC injury will ultimately pursue surgical intervention.…”

“…The triangular fibrocartilage is a complex of soft-tissue structures in the wrist composed of the articular disk, dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnolunate and ulnotriquetral ligaments, and the sheath of the extensor carpi ulnaris. 1,2 The articular fibrocartilage disk covers the ulnar head and serves as a shock absorber for axial loads transmitted through the wrist, 1,3 whereas the dorsal and volar radioulnar ligaments attaching at the ulnar styloid and ulnar fovea function as major stabilizers of the distal radial ulnar joint (DRUJ). 4 Damage to the triangular fibrocartilage complex (TFCC) is one of the most common causes of ulnarsided wrist pain.…”

“…21,22 Despite these technical advancements, research on outcomes after surgical repair of the TFCC has lagged behind with current literature consisting primarily of small retrospective case series with mid-term followup. 3,16,18,[23][24][25][26] Given the improved ability to detect these injuries and the expanded surgical toolset available to treat them, a deeper understanding of surgical outcomes would assist both patients and clinicians in clinical decision making.…”