Variation in Repair of the Triangular Fibrocartilage Complex

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Imaging
• Wrist Anatomy

Background:

• Controversy exists regarding the clinical value of triangular fibrocartilage complex (TFCC) repair.
• The efficacy of TFCC repair in settings beyond acute distal radius fractures remains uncertain.
• Significant variability in TFCC repair practices among surgeons is suspected.

Purpose of the Study:

• To determine the rate of TFCC repair in patients with ulnar-sided wrist pain and MRI-detected TFCC signal changes.
• To test the hypothesis that demographic or surgeon factors are associated with TFCC repair.
• To identify factors influencing the decision for TFCC surgical repair.

Main Methods:

• Retrospective study of 394 patients with ulnar-sided wrist pain and TFCC MRI abnormalities.
• Exclusion of patients with documented distal radioulnar joint (DRUJ) instability.
• Statistical analysis focused on TFCC repair as the primary outcome to identify associated factors.

Main Results:

• Only 6% (25 of 394) of patients underwent TFCC repair.
• A small group of surgeons (10%) performed the majority (80%) of TFCC repairs.
• Perceived trauma history and ulnar-sided TFCC signal changes on MRI were associated with higher repair rates.

Conclusions:

• TFCC repair rates exhibit substantial surgeon-to-surgeon variability.
• Patient perception of injury appears to influence treatment decisions for TFCC tears.
• Decision aids may help mitigate surgeon bias and patient misperception, reducing practice variation.