The Natural History of Non-operatively Treated Traumatic Triangular Fibrocartilage Complex Tears: A Systematic Review

Abstract

Purpose Operative treatment of triangular fibrocartilage complex (TFCC) tears has been well researched; however, data regarding nonoperative management is mixed and scarce. Our review aimed to utilize available data to formulate conclusions regarding treatment algorithms for this heterogeneous injury group.

Methods A thorough literature review was performed in Medline (OVID), Embase, Cochrane Library, and PubMed databases with search terms including “triangular fibrocartilage complex” and variations on the full term including “triangular fibrocartilage” or “TFCC,” alongside “non-operative” and “conservative.” Results were then subject to inclusion criteria, ultimately identifying eight studies.

Results The studies involved a total of 425 patients and 427 wrists for analysis. The mean age ranged from 30.7 years to 60.4 years. 53.6% of patients were male. The mean follow-up ranged from 12 months to 7 years, with an overall mean follow-up period of 27 months. Primary endpoints focused on various functional outcome scores, range of motion, grip strength, and pain. The nonoperative management of TFCC tears resulted in noninferior and comparable outcomes to operative management.

Conclusion Our review identified that the nonoperative management of Palmer-type IB tears with a short period of above-elbow immobilization was an effective treatment option with good functional outcome scores. The nonoperative management of general TFCC tears resulted in comparable functional outcomes when viewed alongside results from other systematic reviews. Risk factors for developing a poor functional outcome or requiring operative management included distal radioulnar joint subluxation, short-arm immobilization, and full tears of the foveal attachment. However, further randomized controlled trials with homogenous data collection are required to make further conclusions regarding the management of this condition.

Keywords

Triangular fibrocartilage complex - TFCC - Nonoperative - Conservative

Publication History

Received: 10 February 2024

Accepted: 21 March 2024

Article published online:
24 April 2024

• References

• 1 Skalski MR, White EA, Patel DB, Schein AJ, RiveraMelo H, Matcuk Jr GR. The traumatized TFCC: an illustrated review of the anatomy and injury patterns of the triangular fibrocartilage complex. Curr Probl Diagn Radiol 2016; 45 (01) 39-50
• 2 Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand: which one to choose?. Int Orthop 2008; 32 (01) 1-6
• 3 Dunn JC, Polmear MM, Nesti LJ. Surgical repair of acute TFCC injury. Hand (N Y) 2020; 15 (05) 674-678
• 4 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 5 Liu EH, Suen K, Tham SK, Ek ET. Surgical repair of triangular fibrocartilage complex tears: a systematic review. J Wrist Surg 2021; 10 (01) 70-83
• 6 Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018; 5 (01) 6
• 7 Feitz R, Khoshnaw S, van der Oest MJW. et al; Hand-Wrist Study Group. Long-term patient-reported outcomes for open surgery of the triangular fibrocartilage complex. Bone Jt Open 2021; 2 (11) 981-987
• 8 Page MJ, McKenzie JE, Bossuyt PM. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372 (71) n71
• 9 Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003; 73 (09) 712-716
• 10 Lindau T, Adlercreutz C, Aspenberg P. Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures. J Hand Surg Am 2000; 25 (03) 464-468
• 11 Lindau T, Hagberg L, Adlercreutz C, Jonsson K, Aspenberg P. Distal radioulnar instability is an independent worsening factor in distal radial fractures. Clin Orthop Relat Res 2000; (376) 229-235
• 12 Souer JS, Ring D, Matschke S, Audige L, Marent-Huber M, Jupiter JB. AOCID Prospective ORIF Distal Radius Study Group. Effect of an unrepaired fracture of the ulnar styloid base on outcome after plate-and-screw fixation of a distal radial fracture. J Bone Joint Surg Am 2009; 91 (04) 830-838
• 13 Lee SK, Kim KJ, Cha YH, Choy WS. Conservative treatment is sufficient for acute distal radioulnar joint instability with distal radius fracture. Ann Plast Surg 2016; 77 (03) 297-304
• 14 Xiao JY, Liu B, Li L, Shi HF, Wu F. Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears. Bone Joint J 2021; 103-B [phone]
• 15 Sander AL, Sommer K, Kaiser AK, Marzi I, Frank J. Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint. Eur J Trauma Emerg Surg 2021; 47 (05) 1621-1625
• 16 Im J, Kang SJ, Lee SJ. A comparative study between conservative and surgical treatments of triangular fibrocartilage complex injury of the wrist with distal radius fractures. Clin Orthop Surg 2021; 13 (01) 105-109
• 17 Hearon BF, Frantz LM, Helsper EA, Morris HA. Experience with diagnosis and management of distal radioulnar joint instability. J Wrist Surg 2021; 10 (05) 392-400
• 18 Lim SH, Kim YH, Lee JS. Normative data on grip strength in a population-based study with adjusting confounding factors: Sixth Korea National Health and Nutrition Examination Survey (2014-2015). Int J Environ Res Public Health 2019; 16 (12) 2235
• 19 McNamara CT, Colakoglu S, Iorio ML. A systematic review and analysis of Palmer Type I Triangular fibrocartilage complex injuries: outcomes of treatment. J Hand Microsurg 2020; 12 (02) 116-122
• 20 Demino C, Morales-Restrepo A, Fowler J. Surgical management of triangular fibrocartilage complex lesions: a review of outcomes. JHS GO. 2019; 1 (01) 32-38