Outcomes of Simultaneous Open Triangular Fibrocartilage Complex Repair with Extensor Carpi Ulnaris Stabilisation

Background: Triangular fibrocartilage complex (TFCC) disruption and extensor carpi ulnaris (ECU) instability are common concomitant injuries. This study presents outcomes of simultaneous open TFCC repairs with ECU stabilisation. Methods: This retrospective cohort study reviewed patients with symptomatic distal radio-ulnar joint (DRUJ) instability and ECU subluxation who underwent simultaneous open repair of the TFCC and ECU stabilisation between 2014 and 2016. Patients were diagnosed clinically, and TFCC tear and ECU subluxation were confirmed using magnetic resonance imaging (MRI) and ultrasound (US), respectively. All patients initially underwent therapy, and surgery was offered to those with persistent symptoms. Open foveal repair of the TFCC was performed using suture anchors, while ECU stabilisation was done by deepening of the ECU groove and subsheath reconstruction. Data collected included demographics, injury details, pre- and post-surgical symptoms, range of motion, grip strength and the modified Mayo wrist score (MMWS). Results: Eleven patients were included in the study. They presented with ulnar-sided wrist pain that limited their activities of daily living. All could recall a specific injury prior to the onset of symptoms. All patients had improvement in measured outcomes after surgery. The preoperative difference in mean arc of motion between the injured and uninjured wrist improved after surgery. The mean grip strength of the injured wrist compared to the uninjured wrist improved from 72% to 93%. The mean MMWS improved from 66.4 before surgery to 92.7 after surgery. Ten of eleven patients were pain-free at the last review, and all could carry out daily activities comfortably. The follow-up duration averaged 18 months (range: 3 months-4 years). Conclusions: The outcomes of simultaneous open repair of the TFCC and stabilisation of the ECU are excellent. Patients with DRUJ instability should be screened for ECU instability, and both pathologies should be addressed simultaneously. Level of Evidence: Level IV (Therapeutic).