Triangular fibrocartilage complex injury: outcomes of operative and non-operative management

The prevalence TFCC injuries has increased over time. However, there remains a lack of understanding of its natural history. Along with the paucity of evidence on treatment options, there is lack of consensus on how best to manage them. This is a retrospective study with subgroup cohort analysis, examining variables and management options associated with patient-reported disability and pain.

Patients from a metropolitan health network who have been referred for Magnetic Resonance Imaging (MRI) of the wrist between 2010 and 2019 and identified to have TFCC injury, were followed up to determine patient-reported outcomes. Disability of arm shoulder and hand scores (DASH) and visual assessment pain scale (VAS) were used to measure disability and pain respectively. An 'excellent' DASH and VAS scores were defined as ≤10 and ≤2, respectively.

One hundred and twenty-four patients met the inclusion criteria and consented to participate in this study. There were 53 patients with excellent DASH score, 95 excellent VAS score and 51 excellent outcomes at mean follow-up of 75.5 months (Range: 5-402.8 months). Concomitant pathology and surgical management were less likely to have excellent DASH and VAS scores, while traumatic aetiology and smoking were less likely to have excellent VAS score. Age was not predictive of excellent DASH or VAS score.

Surgical management of TFCC injuries were associated with worse outcomes than if they were left alone. Smoking cessation is a patient-modifiable risk factor that may help improve outcomes.