American Association for Hand Surgery

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Arthroscopic Wafer Procedure and Foveal Repair for Combined Tear of the Triangular Fibrocartilage Complex
Ji-Sup Kim, M.D., Ph.D.1, Kyeong Eon Kim, M.D.1, YuSeoung Lee, M.D.1, Il Hyun Koh, M.D., Ph.D.2, YunRak Choi, M.D., Ph.D.2; HeeSeok Moon, M.D.1
(1)Ewha Womans University Seoul Hospital, Seoul, Seoul, Korea, Republic of (South), (2)Yonsei University College of Medicine, Seoul, Seoul, Korea, Republic of (South)

Introduction

Combined tears of the triangular fibrocartilage complex (TFCC), involving both central disc disruption and foveal detachment, are a common cause of ulnar-sided wrist pain and distal radioulnar joint (DRUJ) instability. Management often considers the degree of ulnar variance (UV), with ulnar shortening osteotomy (USO) favored when UV exceeds 3 mm due to concerns about ongoing impaction. The arthroscopic wafer procedure, involving partial resection of the ulnar head, has emerged as a less invasive alternative. This study evaluated outcomes of wafer procedure combined with foveal repair and compared patients with UV ? 3 mm versus UV < 3 mm.

Material & Methods

This retrospective study included 59 patients (mean age 52.0 ± 11.6 years) with combined TFCC tears who underwent arthroscopic foveal repair using a bone tunnel technique with a concurrent wafer procedure. Patients were categorized into two groups: Group 1 (UV ? 3 mm, n = 30) and Group 2 (UV < 3 mm, n = 29). Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) score, modified Mayo wrist score, grip strength, wrist range of motion (ROM), and radiographic UV. The minimum follow-up was 24 months (mean 30.3 ± 9.0 months). The Mann-Whitney U test was used due to non-normal data distribution.

Results

All patients showed significant clinical improvement. Mean DASH scores decreased from 35.4 to 13.4, Mayo wrist scores improved from 67.2 to 93.1, and UV decreased from 2.91 mm to 0.94 mm (all p < 0.001). Grip strength and ROM also improved significantly. No significant differences were found between groups in postoperative DASH, Mayo scores, grip strength, or flexion-extension arc. Group 2 showed slightly greater prono-supination arc (p = 0.014), but the difference was not functionally limiting. One patient (1.7%) developed DRUJ osteoarthritis; no major complications were observed.

Conclusion

Arthroscopic wafer procedure combined with foveal TFCC repair is an effective treatment for complex TFCC tears across varying UV levels. Patients with UV ? 3 mm achieved outcomes comparable to those with UV < 3 mm, suggesting that the wafer procedure may serve as a less invasive alternative to USO in select cases. These findings support its broader use in wrist preservation surgery.
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