Abstract
Background There is controversy regarding the value of repair of the triangular fibrocartilage
complex (TFCC). Given that an acute tear of the TFCC associated with a displaced distal
radius fracture uncommonly benefits from repair, the role of repair in other settings
is uncertain. Our impression is that TFCC repair is highly variable from surgeon-to-surgeon.
Purpose The purpose of this study is to determine the rate of TFCC repair in patients who
had a magnetic resonance imaging (MRI) scan of the wrist obtained for ulnar-sided
wrist pain, and that showed signal changes in the TFCC. We tested the primary null
hypothesis that there are no demographic or surgeon factors associated with repair
of the TFCC.
Patients and Methods Three hundred and ninety-four patients with ulnar-sided wrist pain and an MRI scan
showing changes in the TFCC were included in this retrospective study. No patients
had instability of the distal radioulnar joint (DRUJ) recorded in the medical record.
Surgical repair of TFCC tears was used as the primary outcome during statistical analysis
to identify factors associated with repair.
Results Out of 394 (6%), 25 patients underwent TFCC repair. We found that 10% of the treating
surgeons (4 out of 41) performed 80% of the procedures (20 out of 25). Patients who
discerned a trauma prior to their symptoms and patients whose MRI showed signal changes
primarily in the ulnar portion of the TFCC were more likely to have surgical repair.
Conclusion We found that the rate of TFCC repair varies substantially from surgeon-to-surgeon.
The observation that repair is more likely to happen when patients perceive themselves
as injured suggests that perception of injury affects how patients and surgeons consider
treatment options. To help avoid surgeries based on surgeon bias or patient misperception,
we suggest studying the effect of tools that provide simple, balanced, dispassionate,
and empowering information (e.g., decision aids) that can limit surgeon-to-surgeon
variation.
Level of Evidence Level IV.
Keywords
magnetic resonance imaging - repair - surgery - triangular fibrocartilage complex
