Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears

Purpose To determine whether traumatic triangular fibrocartilage complex (TFCC) tears treated by arthroscopic repair have improved functional outcome scores, range of motion, grip strength, and pain relief compared with those repaired using an open surgical technique. Methods From 1997 to 2006, 75 patients had repair of traumatic TFCC tears. Thirty-six patients had arthroscopic TFCC repair, and 39 patients had open repair. One patient was lost to follow-up. Evaluation included range of motion, grip strength, preoperative and postoperative Mayo Modified Wrist Score (MMWS), and patient-reported Disabilities of the Arm, Shoulder, and Hand score and visual analog scale score. Data were analyzed using chi-square tests or 2-sample t-tests; significance was set at p < .05. Results Mean follow-up was 43 months +/- 11. Mean MMWS improved 6.5 points +/- 19.9 after surgery. Fifty-seven percent of patients improved at least I level in the MMWS pain score. No statistical difference was found between open and arthroscopic repair in the improvement of MMWS or visual analog scale pain scores. There was increased postoperative nerve pain (ulnar nerve branch) in the open group (14 out of 39 patients) compared with the arthroscopic group (8 out of 36 patients), but this was not found to be statistically significant. Reoperation for distal radioulnar joint instability was performed in 17% of patients. No statistical association was observed between surgery type and the rate of reoperation for instability. Female gender was significantly associated with a higher rate of total reoperation. Conclusions There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. Although not statistically significant, there was an increased rate of postoperative superficial ulnar nerve pain in the open group (14 out of 39 patients) compared with the arthroscopic group (8 out of 36 patients). After TFCC repair, 13 out of 75 patients required reoperation for distal radioulnar joint instability in this sample. A statistically significant association was found between reoperation rate and female gender.