Dorsal Triangular Fibrocartilage Complex Arthroscopic Repair

Dorsal triangular fibrocartilage complex (TFCC) is a newer entity of its family, which was not included in the Palmer classification. We believe that tear of the dorsal TFCC can cause pain and disability. Literature on this type of tear is limited, in addition, outcomes post-repair, especially arthroscopically, are scarce.

This article defines dorsal TFCC anatomy and investigates the clinical and functional outcomes post-TFCC dorsal tear arthroscopic repair.

An 18-year retrospective review of 32 patients with arthroscopic repair of TFCC dorsal tears was performed. We categorised our patients into group (1) with only isolated TFCC dorsal tear and group (2) also with other concomitant TFCC tear. We evaluated their clinical and functional outcomes and also compared the two groups with other cofactors.

The mean follow-up period was 44 months. In the isolated dorsal tear group ( N  = 17), the wrist performance score was improved from 29 to 37 ( p  = 0.01), the Visual Analog Scale (VAS) score was improved from 6 to 3 ( p  < 0.01), Modified Mayo Wrist Score (MMWS) was improved from 60 to 74 ( p  = 0.01), and the hand grip strength was improved from 18 to 28 kg ( p  = 0.05). In the complex tear group ( N  = 9), VAS score was improved from 6 to 3 ( p  = 0.01) and the MMWS was improved from 44 to 79 ( p  = 0.01). Distal radioulnar joint stability was improved in the isolated group, achieving 100% stability after surgery ( p  < 0.01). No prognostic factors were identified. We noticed that patients who had surgery 9 months post-injury, would have the highest improvement on wrist flexion ( p  = 0.03), comparing with those who had surgery at other time points.

We define dorsal TFCC as the area located between the horizontal dorsal superficial radioulnar ligament and the vertical dorsal capsular wall, that is, the extensor carpi ulnaris subsheath and extensor digiti minimi sheath. To our knowledge, internationally, we have operated and collected the largest series of TFCC dorsal tear arthroscopic repair. Our patients were benefited with significant pain relief with improved daily activities performance.

Dorsal TFCC tear can cause symptoms and is often missed, even during arthroscopic examination. We should consider offering wrist arthroscopy to patient who suffers from ulnar-sided wrist pain, even with negative radiological findings and 9 months post-injury, for diagnostic and therapeutic purposes.