J Wrist Surg 2021; 10(01): 070-083
DOI: 10.1055/s-0040-1718913
Survey or Meta-analysis

Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review

Edward H. Liu
1   Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
,
Kary Suen
1   Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
,
Stephen K. Tham
1   Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
2   Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
3   Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
4   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
,
Eugene T. Ek
1   Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
3   Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
4   Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
5   Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
› Author Affiliations
Funding None.

Abstract

Objective This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears.

Methods A systematic review of MEDLINE and EMBASE was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The focus was on traumatic Palmer 1B ulna-sided tears. Twenty-seven studies were included, including three comparative cohort studies.

Results There was improvement in all functional outcome measures after repair of TFCC tears. The outcomes following peripheral and foveal repairs were good overall: Mayo Modified Wrist Evaluation (MMWE) score of 80.1 and 85.1, Disabilities of the Arm, Shoulder and Hand (DASH) score of 15.7 and 15.8, grip strength of 80.3 and 92.7% (of the nonoperated hand), and pain intensity score of 2.1 and 1.7, respectively. For peripheral tears, transosseous suture technique achieved better outcomes compared with capsular sutures in terms of grip strength, pain, Patient-Rated Wrist Evaluation (PRWE), and DASH scores (grip 85.8 vs. 77.7%; pain 1.5 vs. 2.2; PRWE 11.6 vs. 15.8; DASH 14.4 vs. 16.1). For foveal tears, transosseous sutures achieved overall better functional outcomes compared with suture anchors (MMWE 85.4 vs. 84.9, DASH 10.9 vs. 20.6, pain score 1.3 vs. 2.1), but did report slightly lower grip strength than the group with suture anchors (90.2 vs. 96.2%). Arthroscopic techniques achieved overall better outcomes compared with open repair technique.

Conclusion Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates.

Level of Evidence This is a Level IV, therapeutic study.



Publication History

Received: 30 May 2020

Accepted: 14 September 2020

Article published online:
04 November 2020

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