What Is the Effect of the Ulnar-Plus Variance on the Outcomes of Arthroscopic Repair of the Peripheral Ulnar-Side Triangular Fibrocartilage Complex Tear?

Arthroscopy. 2020 Sep;36(9):2415-2422. doi: 10.1016/j.arthro.2020.05.012. Epub 2020 May 20.

Abstract

Purpose: To compare the outcomes of arthroscopic repair of peripheral ulnar-side triangular fibrocartilage complex (TFCC) tears between patients with and without ulnar-plus variance (UPV) and to identify factors associated with index surgery failure in these patients.

Methods: We retrospectively analyzed 50 consecutive patients who underwent arthroscopic repair of peripheral ulnar-side TFCC tears from June 2014 to February 2018. We selected patients who were aged at least 18 years and underwent arthroscopic repair of peripheral ulnar-side TFCC tears. We excluded those with a fractured or dislocated wrist, ulnar impaction syndrome, degenerative or inflammatory arthritis of the wrist, or neurologic conditions that affect upper-extremity function, as well as those who received less than 12 months' follow-up. We evaluated the patients with a visual analog scale for pain in 3 domains (overall, with hard work, and at rest), the Patient-rated Wrist Evaluation, range of motion, and grip strength. Clinical outcomes and arthroscopic findings were compared between patients with and without UPV (UPV group and non-UPV group, respectively). We calculated the relative risk and 95% confidence interval for younger age (<30 years), sex, UPV, and coexisting degenerative central TFCC tear (type 2 tear) to determine the risk factors for arthroscopic repair failure.

Results: No significant differences were noted between the 2 groups regarding visual analog scale pain and Patient-rated Wrist Evaluation scores and rates of excellent or improved outcomes (P > .05). Arthroscopic repair failure was found in 4 patients. A coexisting type 2 TFCC tear was the only significant risk factor (relative risk, 49.5; 95% confidence interval, 2.94-83.96; P = .007) for arthroscopic repair failure.

Conclusions: UPV did not significantly affect the outcomes of arthroscopic repair of peripheral ulnar-side TFCC tears. However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients.

Level of evidence: Level IV, prognostic study.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Arthroscopy / adverse effects*
  • Cartilage Diseases / etiology
  • Female
  • Humans
  • Lacerations
  • Male
  • Middle Aged
  • Pain / etiology
  • Pain Measurement
  • Prognosis
  • Range of Motion, Articular
  • Retrospective Studies
  • Rupture / etiology
  • Treatment Outcome
  • Triangular Fibrocartilage / surgery*
  • Ulna / surgery*
  • Wrist Injuries / surgery*
  • Wrist Joint / surgery*
  • Young Adult