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Open versus arthroscopic management of acute and chronic distal radioulnar joint instability: a systematic review and
Galal Hegazy1, Ahmed I Hammouda2, Mohamed Ramadan2
1Department of Orthopaedic Surgery, Al-Azhar University, P.O. Box 11751, El Nassr Street, Nasr City, Cairo, 11751, Egypt. glalhegazy@azhar.edu.eg.
Background:
Foveal triangular fibrocartilage complex (TFCC) repair can restore distal radioulnar joint (DRUJ) stability, but whether open or arthroscopic techniques provide superior clinical outcomes remains uncertain. This systematic review and meta-analysis compared functional outcomes, DRUJ stability, and complications between open versus arthroscopic foveal TFCC repair for acute and chronic post-traumatic DRUJ instability.
Methods:
PubMed, Scopus, and Cochrane CENTRAL were searched initially in January 2026 and updated on 15 April 2026 to identify comparative studies of open versus arthroscopic TFCC foveal repair published from January 2000 onward. Adult patients undergoing open or arthroscopic TFCC foveal repair for DRUJ instability were included. Non-comparative studies, abstracts, and non-English publications were excluded. Extracted outcomes included Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analogue Scale (VAS) score for pain, grip strength, range of motion, recurrent instability, and complications. Random-effects meta-analysis pooled standardized mean differences (SMDs) for continuous outcomes and odds ratios (ORs) for binary outcomes. Risk of bias was assessed using ROBINS-I, and certainty of evidence using GRADE. Exploratory subgroup analysis by injury chronicity at study level was performed.
Results:
Five observational studies (Level II-III evidence; 322 wrists: 181 open, 141 arthroscopic) met inclusion criteria. ROBINS-I rated two studies at moderate and three at serious risk of bias; GRADE certainty was low to very low across outcomes. Pooled results showed no statistical differences: MMWS (SMD - 0.12, 95% CI - 0.47 to 0.23; I² = 0%, τ² = 0; p = 0.719); DASH score (SMD 0.22, 95% CI - 0.96 to 1.40; I² = 86.7%, τ² = 0.48; p < 0.0001); PRWE (SMD - 0.24, 95% CI - 2.85 to 2.38; I² = 93.3%, τ² = 1.03; p < 0.0001); VAS (SMD - 0.35, 95% CI - 1.69 to 0.99; I² = 89.9%, τ² = 0.63; p < 0.0001); recurrent instability OR (1.00, 95% CI 0.19 to 5.37; I² = 63.2%, τ² = 1.18; p = 0.028). Exploratory subgroup synthesis restricted to predominantly chronic cohorts did not materially alter pooled estimates.
Conclusions:
Both open and arthroscopic foveal TFCC repair can improve function, pain, motion, grip strength, and distal radioulnar joint stability, but current comparative evidence does not demonstrate clear superiority of either technique. Because the available evidence is limited to a small number of non-randomized studies with substantial heterogeneity and low certainty, the absence of statistically significant differences should be interpreted cautiously and should not be considered evidence of clinical equivalence. In addition, although SMDs were appropriate for the present meta-analysis given heterogeneity in outcome reporting, they reduce the clinical interpretability. Surgical choice should therefore remain individualized until higher-quality comparative studies become available.
Trial Registration:
PROSPERO registration: CRD42025638530.
