Factors Associated with Reoperation After Triangular Fibrocartilage Complex (TFCC) Debridement
Svenna HWL Verhiel, MD; Massachusetts General Hospital / Harvard University, Boston, MA; Marco JPF Ritt, MD, PhD
VU Medical Center, Amsterdam, Netherlands; Neal C Chen, MD; Massachusetts General Hospital, Boston, MA
Introduction Few studies analyze factors associated with reoperation after triangular fibrocartilage complex (TFCC) debridement. Of these studies, positive ulnar variance and incidence of associated lunotriquetral ligament tears are factors implicated in worse clinical outcomes and complications. The aim of this retrospective database study is to identify factors associated with unplanned reoperation after TFCC debridement. Furthermore, we aim to determine the rate and type of reoperation after TFCC debridement, and to report on complications and persistence of ulnar-sided wrist pain after TFCC surgery.
Methods & Materials In this retrospective study, we included all patients older than 18 years of age who underwent TFCC debridement between January 2003 and December 2017. Medical records of patients were assessed for our explanatory variables, unplanned reoperations, complications and reporting of symptoms. We used bivariate (Mann-Whitney U test and Fisher's exact test) and multivariable analyses to identify factors associated with unplanned reoperation after TFCC debridement.
Results Among 163 TFCC debridement procedures, there were 31 unplanned reoperations (19%) (Table 1). Seventeen patients underwent ulna shortening osteotomy (10%), 7 patients underwent a revision TFCC debridement (4.3%) and 7 patients underwent surgery of a different type (4.3%). In multivariable analysis, a positive ulnar variance appeared to be the only factor independently associated with unplanned reoperation (odds ratio 4.5; 95% CI 1.5-14) (Table 2). Twenty-three patients experienced a complication (14%), the most common being extensor carpi ulnaris (ECU) tendinitis/tenosynovitis (n=9; 5.5%) and symptoms of the dorsal sensory branch of the ulnar nerve (n=5; 3.1%) (Table 3). At final follow-up, 15 out of 163 patients (9.2%) reported persistent ulnar-sided wrist pain.
Conclusions TFCC debridement yields satisfactory pain-relief with acceptable reoperation and complication rates. This study can help inform decision making as patients with ulna positive variance have about a 4-fold increased odds of revision surgery involving ulna shortening after arthroscopic debridement.
Level of Evidence: level II – prognostic
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