Debridement Alone Versus Debridement and Ulnar Shortening Osteotomy for the Treatment of TFCC Tears: A Retrospective Comparative Analysis.

Abstract

Introduction: While arthroscopic TFCC debridement (TFCC-D) has proven successful for the treatment of pathological tears, a subset of patients may present with persistent or recurrent ulnar-sided wrist pain and require revision debridement, repair, and/or ulnar shortening osteotomy (USO). We present a retrospective comparative study that evaluates the clinical outcomes of 83 patients who underwent TFCC-D (N=17) or TFCC-D+USO (N=66).

Materials and methods: Preoperative ulnar variance was measured on standard posteroanterior (PA) view and gripping PA view radiographs. Clinical outcomes at final follow up included visual analog scale (VAS) pain scores, grip and pinch strength recovery, active wrist range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient Rated Wrist Evaluation (PRWE) questionnaires.

Results: We report on 83 cases, mean age 45 years (range, 18-74 years), who underwent surgery between September 2016 and March 2020. Mean follow-up time was 93 weeks (range, 49-237 weeks). Mean VAS scores decreased from 7.4 to 5.3 in the TFCC-D group and from 6.7 to 2.9 in the TFCC-D+USO group. Patients in the TFCC-D group reported significantly higher QuickDASH (44.6 vs. 17.0) and PRWE scores (76.8 vs. 30.7) compared to the TFCC-D+USO group. Nine TFCC-D cases were indicated for revision compared with one TFCC-D+USO case. Eight of the nine TFCC-D cases indicated for revision exhibited positive ulnar variance on gripping PA view.

Conclusions: Patients treated with TFCC-D+USO reported superior outcomes to those treated with TFCC-D alone on the basis of pain scores, QuickDASH and PRWE scores, and need for revision surgery.