Repair of the Triangular Fibrocartilage Complex After Ulnar-Shortening Osteotomy: Second-Look Arthroscopy

Purpose

Ulnar shortening is a widely used procedure for various conditions associated with ulnar wrist pain, including triangular fibrocartilage complex (TFCC) injury; however, few reports have examined the condition of the TFCC after osteotomy. The central avascular zone of the TFCC generally is considered to have no potential to heal. This study investigated whether the avascular zone of the TFCC has any potential for repair, and whether repair of the torn disc proper correlates with clinical findings.

Methods

Between 1987 and 2005, we performed 75 second-look arthroscopies after an ulnar-shortening osteotomy for ulnar wrist disorders. Of these, 32 wrists with a TFCC (disc proper) tear on first arthroscopy were included in this study. Data from patient charts, radiography, and video images of arthroscopy were reviewed retrospectively. Tears of the disc proper were classified as radial, central, or ulnar tears, and as either linear or round tears.

Results

Meticulous second-look arthroscopy showed repair of tears in 50% of studied wrists. Round tears tended to repair better than linear tears. Although the final clinical score was better in repaired wrists than in nonrepaired wrists, no marked differences were noted between groups in terms of age, gender, preoperative ulnar variance, follow-up period, or surgical procedures used.

Conclusions

The avascular zone of the TFCC possesses some potential for repair; however, factors promoting spontaneous repair of this tissue were not identified.

Type of study/level of evidence

Therapeutic IV.

Key words: Triangular fibrocartilage complex, repair, ulnar-shortening osteotomy, ulnocarpal wrist pain