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The Use of Wrist Arthroscopy in the Management of Triangular Fibrocartilage Complex (TFCC) Tears and Distal Radius Fractures
Eitan Melamed, MD; Jessica Lavery, MS; John T. Capo, MD; Heather Taffet Gold, PhD
New York University, New York, NY
Introduction: Wrist arthroscopy is a valuable diagnostic and therapeutic tool for conditions of the triangular fibrocartilage complex (TFCC) and distal radius fractures. Little is known about population-based trends in utilization of open vs. arthroscopic surgery for TFCC tears or distal radius fractures. This study aimed to investigate the use of wrist arthroscopy in the management of TFCC tears and concurrent wrist arthroscopy at the time of operative treatment of distal radius fractures in New York (NY) State.
Methods: The NY Statewide Planning and Research Cooperative System (SPARCS; 2003-2013) database was utilized to identify type of surgical treatment for all cases of TFCC tears and distal radius fractures treated in the ambulatory surgery setting. For TFCC tears, patients were categorized as having an open repair, arthroscopic repair, or both. Surgical treatment for distal radius fracture was classified as open or percutaneous repair, arthroscopic repair, or both concurrently. Chi-square tests were used to determine if type of surgical treatment varied by surgery year and demographic characteristics (age, sex).
Results: 7,578 cases of TFCC tears identified. Arthroscopy alone was the most frequently used surgical treatment for TFCC tears (n=6,118, 80.7%), followed by open repair only (n=1,091, 14.4%) and open and arthroscopic (n=369, 4.9%). The rate of arthroscopy fluctuated between 75.0% and 85.3% over time, with no distinct pattern (p<0.0001). Older age was associated with increased use of arthroscopy until age 70+ years, at which point there was a decrease in the rate of arthroscopy utilization (p=0.005). Female patients were more likely to have arthroscopic repair (84.2% v 77.3%, p<0.0001). Unlike TFCC surgery, the 28,554 patients with a distal radius fracture were most frequently treated with open or percutaneous surgery alone (n=28,356, 99.3%). Only 0.2% (n=69) and 0.5% (n=129) of distal radius fracture cases were treated with arthroscopic repair alone or concurrent arthroscopic repair and open or percutaneous fixation, respectively. Finally, the use of wrist arthroscopy decreased with increasing age (0.6% in patients aged 20-29 v. 0.1% in patients 70+, p=0.003).
Conclusion: Arthroscopic repair was performed for TFCC tears more frequently in female patients and in older patients until 70 years. The use of arthroscopic TFCC repair was fairly stable throughout the years, as was the incidence of concomitant arthroscopic repair and open repair of the TFCC. Despite evidence in favor of arthroscopic-assisted distal radius fixation for certain fracture patterns, it appears that only a small proportion of cases in NY State underwent these procedures.
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