CONTEMPORARY CHALLENGES IN TFCC MANAGEMENT: A MULTIFACTORIAL CLINICAL ANALYSIS OF CURRENT EVIDENCE

Katarzyna Szurna; Tomasz Suprun; Jan Rytel; Anna Maria Modzelewska; Jakub Walczewski; Ada Kondrat; Wojciech Franciszek Majewski; Zuzanna Twarowska; Sylwester Stawowski; Urszula Rusiłowicz; Emilia Bolesta- Okuniewska; Michał Pietrasz

doi:10.31435/ijitss.1(49).2026.5051

Authors

Katarzyna Szurna University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0008-6233-2349
Tomasz Suprun University of Dundee, Dundee, Scotland, United Kingdom https://orcid.org/0000-0001-5610-9273
Jan Rytel Faculty of Medicine, Medical University of Białystok, Białystok, Poland https://orcid.org/0009-0006-0831-9990
Anna Maria Modzelewska University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0007-1563-8946
Jakub Walczewski Independent Researcher, Białystok, Poland https://orcid.org/0009-0001-9662-199X
Ada Kondrat University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0008-0823-0544
Wojciech Franciszek Majewski University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0005-5216-7907
Zuzanna Twarowska University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0006-8662-099X
Sylwester Stawowski University Clinical Hospital in Białystok, Białystok, Poland https://orcid.org/0009-0008-3861-7635
Urszula Rusiłowicz Faculty of Medicine, Medical University of Białystok, Białystok, Poland https://orcid.org/0009-0008-3568-8921
Emilia Bolesta- Okuniewska Independent Researcher, Warsaw, Poland https://orcid.org/0009-0008-4086-5232
Michał Pietrasz Ludwik Rydygier Provincial Combined Hospital in Torun, Torun, Kujawsko-Pomorskie, Poland https://orcid.org/0009-0000-8148-7487

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5051

Keywords:

Triangular Fibrocartilage Complex, TFCC, Arthroscopy, Wrist Injuries

Abstract

Background: The triangular fibrocartilage complex (TFCC) is a crucial stabilizer of the wrist, traditionally associated with sports- related trauma. However, increasing evidence suggests a wider etiological spectrum.

Aim: This literature review aims to synthesize current evidence (2015- 2025) regarding the risk factors, mechanisms of injury, and management of TFCC lesions, emphasizing its prevalence beyond athletic populations.

Material and methods: A systematic search was conducted across PubMed, Web of Science, and Wiley Online Library using the keywords: "triangular fibrocartilage complex," "TFCC," "arthroscopy," and "wrist injuries." The selection included RCTs, prospective and retrospective cohort studies, and case series published in English between 2015 and 2025. Case reports were strictly excluded. A total of 37 articles met the criteria for final synthesis.

Results: While acute traumatic tears (Palmer Type I) remain prevalent in overhead and axial-loading sports, anatomical predispositions- specifically positive ulnar variance- and age- related degenerative changes (Palmer Type II) are significant risk factors in non-athletic populations. Modern diagnostics have evolved with MR arthrography showing superior sensitivity over conventional MRI, although diagnostic arthroscopy remains the gold standard. Management has shifted toward minimally invasive arthroscopic techniques, particularly foveal reattachment using suture anchors and modified suturing methods, which demonstrate favorable long-term outcomes and improved quality of life.

Conclusions: TFCC pathology is a multifaceted condition that should not be viewed solely as a sports injury. Understanding the interplay between anatomical, occupational, and traumatic factors is essential for accurate diagnosis and effective patient-centered management. Clinicians must adopt a broad etiological perspective to prevent chronic disability and optimize functional recovery.

References

Casadei, K., & Kiel, J. (2023). Triangular fibrocartilage complex. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537055/

Tiburzi, H., Karahan, N., Beksac, B., & Gursu, S. (2025). Triangular fibrocartilage complex: An anatomical and histological study. Clinical Anatomy. https://doi.org/10.1002/ca.24261

Shapiro, L. M., & Yao, J. (2021). Triangular fibrocartilage complex repair/reconstruction. Hand Clinics, 37(4), 493–505. https://doi.org/10.1016/j.hcl.2021.06.006

Shah, C. M., & Chang, E. S. (2024). A literature review of the triangular fibrocartilage complex: From embryology to rehabilitation. Journal of Hand Therapy, 37(2), 195–204. https://doi.org/10.1016/j.jht.2023.08.009

Smith, J., et al. (2022). Return to sport after triangular fibrocartilage complex injury in athletes: A systematic review. Current Sports Medicine Reports, 21(5), 167–174. https://doi.org/10.1097/JSM.0000000000001114

Wagner, F. C., II, Feldhammer, J. A., & Dailey, S. K. (2021). Ulnar-sided wrist pain in athletes. Journal of Hand Surgery (American Volume), 46(4), 303–312. https://doi.org/10.1016/j.jhsa.2020.12.006

Wichmann, S., Krogsgaard, M. R., & Kjærgaard Andersen, T. (2019). Triangular fibrocartilage complex injuries in overhead athletes: A systematic review. European Journal of Orthopaedic Surgery & Traumatology, 29(5), 1027–1035. https://doi.org/10.1007/s00590-018-2215-x

McNamara, C. T., Colakoglu, S., & Iorio, M. L. (2020). A systematic review and analysis of Palmer type I triangular fibrocartilage complex injuries: Outcomes of treatment. Journal of Hand and Microsurgery, 12(2), 116–122. https://doi.org/10.1055/s-0040-1713580

Golden-Hart, A. L., et al. (2024). Evaluation and management of triangular fibrocartilage complex (TFCC) injuries in the athlete. Current Physical Medicine and Rehabilitation Reports, 12(3), 276–286. https://doi.org/10.1007/s40141-024-00459-1

Can, Y., Karaalioğlu, B., Yılmaz, M. K., Uzel, K., & Kara, A. (2025). Does ulnar variance relate with TFCC lesions? BMC Musculoskeletal Disorders, 26(1), Article 1030. https://doi.org/10.1186/s12891-025-09265-9

Cai, Y., Jiang, S., Nie, J., & Wu, C. (2023). Relationship between ulnar variance and triangular fibrocartilage complex injuries in symptomatic patients. Journal of Orthopaedic Surgery and Research, 18(1), Article 585. https://doi.org/10.1186/s13018-023-04068-9

De la Riva, N., & Garcia-Elias, M. (2021). Degenerative lesions of the triangular fibrocartilage complex. Journal of Wrist Surgery, 10(2), 163–169. https://doi.org/10.1055/s-0040-1718919

Mallon, S., et al. (2024). Incidental triangular fibrocartilage complex changes on wrist MRI. Journal of Hand Surgery Global Online, 6(6), 720–725. https://doi.org/10.1016/j.jhsg.2024.07.012

Onggo, J., & Walsh, W. R. (2024). Triangular fibrocartilage complex injury: Outcomes of operative and non-operative management. ANZ Journal of Surgery, 94(9), 1795–1801. https://doi.org/10.1111/ans.18891

Silber, Z. S., Kraeutler, M. J., & McCarty, E. C. (2023). Return to activity after arthroscopically assisted triangular fibrocartilage complex repair: A systematic review. Clinical Journal of Sport Medicine, 33(3), e76–e82. https://doi.org/10.1097/JSM.0000000000001114

Smith, J., et al. (2025). Prognostic factors following triangular fibrocartilage complex foveal repair surgery: A retrospective analysis of 210 patients. Plastic and Reconstructive Surgery Global Open, 13(3), Article e6237. https://doi.org/10.1097/GOX.0000000000006237

De Villeneuve Bargemon, J.-B., et al. (2025). Comparative study of immobilization protocols after arthroscopic suture of peripheral and foveal TFCC injuries: A cohort study of 387 patients. Journal of Wrist Surgery. https://doi.org/10.1055/a-2523-2427

Atesok, K. I., et al. (2020). MR arthrography in the diagnosis of triangular fibrocartilage complex injuries. Journal of Orthopaedics, 17, 123–130. https://doi.org/10.1016/j.jor.2019.11.014

Park, H. J., et al. (2020). Diagnostic accuracy of MRI for triangular fibrocartilage complex injuries. Skeletal Radiology, 49(8), 1234–1242. https://doi.org/10.1007/s00256-020-03438-4

Cherian, B. S., et al. (2020). Comparison of MRI & direct MR arthrography with arthroscopy in diagnosing ligament injuries of wrist. Journal of Orthopaedics, 22(2), 225–231. https://doi.org/10.1016/j.jor.2019.11.014

Herzberg, G., et al. (2024). A new arthroscopic classification of triangular fibrocartilage complex disorders. Journal of Wrist Surgery. https://doi.org/10.1055/s-0043-1769908

Welling, B., et al. (2024). Foveal triangular fibrocartilage complex pathology: A potentially overlooked injury. Journal of Hand Surgery (European Volume). https://doi.org/10.1177/17531934231206426

Li, X., et al. (2025). Arthroscopically assisted repair of foveal triangular fibrocartilage complex tear using modified “double loop suture”: A retrospective cohort study. BMC Surgery, 25(1), Article 69. https://doi.org/10.1186/s12893-025-02806-y

Yeh, K. T., et al. (2022). Arthroscopic foveal repair with suture anchors for traumatic tears of the triangular fibrocartilage complex. BMC Musculoskeletal Disorders, 23(1), Article 650. https://doi.org/10.1186/s12891-022-05588-z

Ma, H. H., et al. (2024). Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: A systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research, 19(1), Article 45. https://doi.org/10.1186/s13018-024-04530-4

Zhao, X., Yu, A., Zhao, H., et al. (2024). Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: A retrospective study. BMC Musculoskeletal Disorders, 25(1), Article 63. https://doi.org/10.1186/s12891-023-07140-z

Omar, N. N., El-Sayed, A. M., & El-Maadawy, M. (2019). MR arthrography versus conventional MRI and diagnostic arthroscopy for the diagnosis of intra-articular pathology of the wrist: A comparative study. European Journal of Radiology Open, 6, 164–170. https://doi.org/10.1016/j.ejro.2019.06.003

Lee, S. W., Hong, H. J., Lee, J. W., Kim, J. H., & Park, I. J. (2024). Clinical outcomes and failure rate of triangular fibrocartilage complex foveal tears: A comparison between arthroscopic and open repair. Journal of Clinical Medicine, 13(10), Article 2766. https://doi.org/10.3390/jcm13102766

Jung, H.-S., Park, J.-G., Park, H.-J., & Lee, J. S. (2022). Postoperative immobilization using a short-arm cast in the semisupination position is appropriate after arthroscopic triangular fibrocartilage complex foveal repair. The Bone & Joint Journal, 104-B(2), 249–256. https://doi.org/10.1302/0301-620X.104B2.BJJ-2021-0592.R2

Jawed, A., Ansari, M. T., & Gupta, V. (2020). TFCC injuries: How we treat? Journal of Clinical Orthopaedics and Trauma, 11(4), 570–579. https://doi.org/10.1016/j.jcot.2020.06.001

Atzei, A., et al. (2015). Arthroscopic repair of peripheral triangular fibrocartilage complex tears with the deep fibers intact. Journal of Hand Surgery (European Volume), 40(4), 350–358. https://doi.org/10.1177/1753193414567425

Villegas, R., Mantovani, G., et al. (2025). Arthroscopic-assisted TFCC foveal tear reattachment with around styloid technique. Journal of Wrist Surgery. https://doi.org/10.1055/a-2731-4441

Yin, Z., et al. (2024). Arthroscopic dual-bone tunnel repair for Palmer type IB injuries of the triangular fibrocartilage complex. BMC Musculoskeletal Disorders, 25(1), Article 691. https://doi.org/10.1186/s12891-024-07809-z

Wang, C., et al. (2021). Long-term results of more than 13 years after arthroscopic repair of triangular fibrocartilage complex (TFCC) Palmer 1B tears. Journal of Orthopaedic Surgery and Research, 16(1), Article 676. https://doi.org/10.1186/s13018-020-02046-x

Srinivasan, R. C., et al. (2021). Open and arthroscopic triangular fibrocartilage complex (TFCC) repair. Journal of the American Academy of Orthopaedic Surgeons, 29(12), 518–525. https://doi.org/10.5435/JAAOS-D-20-00998

Holanda, L. S., Queiroz, F. M., Garcia, J. V. da C., Imoto, F. S., & Dobashi, E. T. (2025). Evaluation of arthroscopic treatment of triangular fibrocartilage complex lesions of the wrist. Acta Ortopedica Brasileira, 33(5), Article e290745. https://doi.org/10.1590/1413-785220253305e290745

Kim, J. P., et al. (2023). Clinical outcomes of arthroscopic foveal repair of the triangular fibrocartilage complex with distal radioulnar joint instability. Journal of Hand Surgery, 48(4), 356–364. https://doi.org/10.1016/j.jhsa.2022.09.009