Intermediate-Term Patient-Reported Outcomes After Foveal TFCC Repair: Timing of Recovery and Successful Return to...

The triangular fibrocartilage complex (TFCC) is a critical stabilizer of the distal radioulnar and ulnocarpal joints. Recent literature has guided surgical practice in addressing deep foveal fibers that are essential for distal radioulnar joint stability. Although foveal TFCC repair has been associated with reduction in pain and improvement in patient-reported outcomes, there is limited literature on the path of the recovery process. The purpose of this retrospective study is to better understand recovery following foveal TFCC repair using the ulnar tunnel technique in both adolescents and adults.

Forty-six patients treated from 2018 to 2023 by a single surgeon with a foveal TFCC repair technique were included. Pre- and post-operative Patient-Reported Outcome Measurement Instrument System (PROMIS) scores and range of motion, as well as complications were analyzed. Thirty-two patients completed follow-up questionnaires at a minimum of 2 years after surgery.

PROMIS pain scores at 12 weeks after surgery were significantly improved; upper extremity and physical function were not significantly improved. At an average of 32 months after surgery, PROMIS upper extremity, pain, and physical function scores were all significantly improved. The vast majority of patients regained wrist and forearm motion by 12 weeks. Complication and reoperation rates were 8.7% and 4.3%, respectively. At an average of 32 month follow-up, 77% of patients had returned to full sports and activity. The highest activity level was achieved at a median of 6 months. Of note, 45% of patients experienced a temporary setback during the recovery period.

Ulnar tunnel repair of foveal TFCC tears is a reproducible and effective technique with good intermediate-term results. Pain and range of motion reliably improve within the first three months; return to activity and maximum functionality may not significantly improve until six months after surgery. One quarter of our cohort did not return to full activity, and many patients experienced a temporary setback during the recovery process. At intermediate-term follow-up of 32 months, patients were doing well by all subjective measures. Patients should be counseled that functional recovery following foveal TFCC repair is not linear and may require more time than expected.

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