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

Purpose: 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 = 410), 24.1 (n = 63), and 17.6 (n = 72), in the arthroscopic repair, open repair, and debridement groups, respectively. Visual analog scale pain scores were 2.4 (n = 289), 1.7 (n = 60), and 2.8 (n = 120), respectively. Modified Mayo wrist scores were 84 (n = 299), 80 (n = 154), and 88.6 (n = 118), respectively. Grip strength was 83.4% (n = 494), 82.9% (n = 94), and 92% (n = 80) of the contralateral hand, respectively. Finally, range of motion flexion-extension was 137° (n = 309), 133° (n = 107), and 130° (n = 57), and pronation-supination was 161° (n = 264), 153° (n = 68), and 167° (n = 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. Key words: arthroscopy, outcomes, repair, TFCC, wrist