Current surgical treatment options for triangular fibrocartilage complex tears

Triangular fibrocartilage complex (TFCC) tears are a major source of ulnar-sided wrist pain and may result in patient disability, ranging from activities of daily living to high-level athletics. A thorough history and physical examination in addition to plain radiographs help to narrow the differential diagnosis. When attempts at nonoperative treatment fail, more advanced imaging is warranted, and surgery may be indicated. Relevant clinical, radiographic, and anatomic factors must be taken into account when planning surgery, which will also include information found at the time of diagnostic arthroscopy. Such factors include duration of symptoms, presence of ulnar positive variance with signs of ulnocarpal impaction, distal radioulnar joint stability and arthritis, tear location and morphology, and involvement of the superficial and foveal TFCC attachments to the ulna. Taking these factors into account, the surgeon must treat the primary and any concomitant pathologies. Surgical options include simple debridement, capsular or foveal-based repair using either arthroscopic or open approaches, ligament reconstruction, or salvage procedures. Ulnar shortening, when appropriate, may be useful both as part of a primary procedure when treating the TFCC, with or without ulnar impaction, or as a salvage procedure for failed TFCC debridement and/or repair. The following overview will discuss the most current surgical indications and treatment options for symptomatic TFCC tears. We discuss our approach and treatment strategies followed by a review of all surgical options and current outcomes data.