From the Guidelines
Surgical intervention for a TFCC tear is considered when conservative treatment fails to provide relief, typically after 4-6 weeks of non-surgical management, and in cases of complete tears, especially Palmer class 1B peripheral tears with distal radioulnar joint instability 1. When considering surgical intervention for a TFCC tear, it's essential to evaluate the patient's symptoms, activity level, and tear characteristics.
- Persistent wrist pain, instability, clicking, or functional limitations despite conservative treatment are indications for surgery.
- Complete tears, particularly Palmer class 1B peripheral tears with distal radioulnar joint instability, are more likely to require surgical intervention.
- The type of surgical procedure depends on the tear location and classification, with options including arthroscopic debridement, repair, or reconstruction.
- Peripheral tears with good tissue quality are typically repaired, while central tears often respond better to debridement, as noted in the treatment of associated ligament injuries, including TFCC tears, at the time of radius fixation 1. The decision for surgery should be individualized based on the patient's age, activity level, occupation, and specific tear characteristics, taking into account the limited healing potential of central tears compared to peripheral tears with better blood supply.
- Arthroscopy is a valuable adjunctive method for evaluating and treating TFCC lesions that are not detectable on standard radiographs, as demonstrated in a level II trial comparing arthroscopic reduction and fixation of distal radius fracture combined with arthroscopic treatment of associated intracarpal ligament and TFCC injuries to fluoroscopic reduction and fixation of the radius alone 1.
From the Research
TFCC Tear Surgical Intervention
Surgical intervention for a Triangular Fibrocartilage Complex (TFCC) tear is considered in certain cases. The decision to operate depends on various factors, including:
- The severity of the injury
- The presence of instability in the distal radioulnar joint (DRUJ)
- The failure of conservative management to provide relief
- The type and extent of the injury
Indications for Surgery
The following are indications for surgical intervention:
- Frank instability of the DRUJ or unstable and displaced fractures 2
- Failure of conservative management to provide relief 2
- Presence of a complete foveal TFCC tear or a dorsally subluxated DRUJ 3
- Coexistence of TFCC tears and positive ulnar variance 4
Surgical Options
The choice of operative treatment is guided by the type and extent of the injury and may include:
- Debridement
- Repair
- Ulnar unloading procedures like shortening or Wafer procedure 2, 4
- Arthroscopic management, which can be instituted successfully in most cases 5, 2
Conservative Management
Conservative management is often the first line of treatment and may include:
- Modification of daily activities to avoid aggravation of pain and injury
- Temporary splint or cast immobilization
- Non-steroidal anti-inflammatory medication
- Corticosteroid injection and physical therapy in grossly symptomatic patients 2
- Above-elbow immobilization, which has been shown to be a viable treatment method, particularly in patients without DRUJ subluxation 3