CONTEMPORARY IMAGING, ARTHROSCOPIC REPAIR, AND FUNCTIONAL REHABILITATION IN TRAUMATIC TRIANGULAR FIBROCARTILAGE COMPLEX TEARS: A NARRATIVE REVIEW

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.6486

Keywords:

Triangular Fibrocartilage Complex, Distal Radioulnar Joint, Magnetic Resonance Imaging, Wrist Arthroscopy, Rehabilitation, Functional Outcomes

Abstract

Traumatic triangular fibrocartilage complex (TFCC) tears are an important cause of ulnar-sided wrist pain, reduced grip strength, restricted forearm rotation, and distal radioulnar joint (DRUJ) instability. Their diagnosis and management remain challenging because morphological abnormalities do not always correlate with symptoms or functional impairment. This narrative review summarizes contemporary concepts in the diagnosis, treatment, and rehabilitation of traumatic TFCC tears, with particular emphasis on modern imaging and arthroscopic technologies. English-language publications were identified through PubMed without restrictions on publication year. The reviewed evidence indicates that diagnosis should integrate the mechanism of injury, physical examination, bilateral assessment of DRUJ stability, and imaging findings. Magnetic resonance imaging and magnetic resonance arthrography improve visualization of TFCC lesions, but incidental abnormalities and variable diagnostic performance limit their use as isolated decision-making tools. DRUJ stability appears to be a key factor in treatment selection. Structured non-operative management may provide satisfactory outcomes in patients with a stable DRUJ, whereas persistent symptoms, mechanically unstable tears, and foveal detachment may require surgical intervention. Contemporary arthroscopic options include all-inside repair, suture-anchor fixation, and transosseous techniques, although current evidence does not establish a single superior method. Postoperative rehabilitation protocols remain heterogeneous, and validated criteria for progression and return to work or sport are lacking. Future research should focus on standardized diagnostic pathways, comparative evaluation of repair techniques, objective functional monitoring, and patient-centered return-to-activity outcomes. Modern technologies should support, rather than replace, integrated clinical and functional assessment.

References

Adams, B. D., & Berger, R. A. (2002). An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. The Journal of Hand Surgery, 27(2), 243–251. https://doi.org/10.1053/jhsu.2002.31731

Adams, B. D., & Holley, K. A. (1993). Strains in the articular disk of the triangular fibrocartilage complex: A biomechanical study. The Journal of Hand Surgery, 18(5), 919–925. https://doi.org/10.1016/0363-5023(93)90066-C

Adams, B. D., Samani, J. E., & Holley, K. A. (1996). Triangular fibrocartilage injury: A laboratory model. The Journal of Hand Surgery, 21(2), 189–193. https://doi.org/10.1016/S0363-5023(96)80099-2

Afifi, A., Abdel-Ati, E. A., Abdel-Wahed, M., & Moharram, A. N. (2022). Arthroscopic-assisted foveal reattachment of triangular fibrocartilage complex tears with distal radioulnar joint instability: A comparison of suture anchors and transosseous sutures. The Journal of Hand Surgery, 47(6), 507–516. https://doi.org/10.1016/j.jhsa.2022.01.021

Anderson, M. L., Skinner, J. A., Felmlee, J. P., Berger, R. A., & Amrami, K. K. (2008). Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain. The Journal of Hand Surgery, 33(7), 1153–1159. https://doi.org/10.1016/j.jhsa.2008.02.028

Atzei, A., Luchetti, R., & Braidotti, F. (2015). Arthroscopic foveal repair of the triangular fibrocartilage complex. Journal of Wrist Surgery, 4(1), 22–30. https://doi.org/10.1055/s-0035-1544226

Atzei, A., Tandioy-Delgado, F. A., Marcovici, L. L., Aust, T. W., & Luchetti, R. (2023). All-inside anatomic arthroscopic (3A) reconstruction of irreparable TFCC tear. Journal of Wrist Surgery, 12(1), 2–8. https://doi.org/10.1055/s-0041-1735981

Bednar, M. S., Arnoczky, S. P., & Weiland, A. J. (1991). The microvasculature of the triangular fibrocartilage complex: Its clinical significance. The Journal of Hand Surgery, 16(6), 1101–1105. https://doi.org/10.1016/S0363-5023(10)80074-7

Boer, B. C., Vestering, M., van Raak, S. M., van Kooten, E. O., Huis in ’t Veld, R., & Vochteloo, A. J. H. (2018). MR arthrography is slightly more accurate than conventional MRI in detecting TFCC lesions of the wrist. European Journal of Orthopaedic Surgery & Traumatology, 28(8), 1549–1553. https://doi.org/10.1007/s00590-018-2215-x

Choi, S. I., Malik, S., & MacLean, S. (2024). The natural history of non-operatively treated traumatic triangular fibrocartilage complex tears: A systematic review. Journal of Wrist Surgery, 13(6), 550–558. https://doi.org/10.1055/s-0044-1786164

Chung, S. R., Huan, K. W. S. J., Nah, J. H., & Jerome, T. J. (2025). Arthroscopic algorithm for acute traumatic triangular fibrocartilage complex (TFCC) tears. Journal of Hand and Microsurgery, 17(1), Article 100175. https://doi.org/10.1016/j.jham.2024.100175

Dunn, J. C., Polmear, M. M., & Nesti, L. J. (2020). Surgical repair of acute TFCC injury. HAND, 15(5), 674–678. https://doi.org/10.1177/1558944719828007

Feitz, R., Stip, D., van der Oest, M., Souer, S., Hovius, S., Selles, R., & Hand-Wrist Study Group. (2021). Prognostic factors in open triangular fibrocartilage complex (TFCC) repair. Journal of Hand Surgery Global Online, 3(4), 176–181. https://doi.org/10.1016/j.jhsg.2021.05.005

Frank, R. M., Slikker, W., Al-Shihabi, L., & Wysocki, R. W. (2015). Arthroscopic-assisted outside-in repair of triangular fibrocartilage complex tears. Arthroscopy Techniques, 4(5), e577–e581. https://doi.org/10.1016/j.eats.2015.06.002

Herzberg, G., Burnier, M., & Nakamura, T. (2021). Arthroscopic anatomy of the TFCC with relevance to function and pathology. Journal of Wrist Surgery, 10(6), 558–564. https://doi.org/10.1055/s-0041-1732416

Herzberg, G., Burnier, M., Ly, L., Nakamura, T., del Piñal, F., & Atzei, A. (2024). A new arthroscopic classification of triangular fibrocartilage complex disorders. Journal of Wrist Surgery, 13(1), 2–8. https://doi.org/10.1055/s-0043-1769908

Infanger, M., & Grimm, D. (2009). Meniscus and discus lesions of triangular fibrocartilage complex (TFCC): Treatment by laser-assisted wrist arthroscopy. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62(4), 466–471. https://doi.org/10.1016/j.bjps.2007.02.035

Iordache, S. D., Rowan, R., Garvin, G. J., Osman, S., Grewal, R., & Faber, K. J. (2012). Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists. The Journal of Hand Surgery, 37(1), 98–103. https://doi.org/10.1016/j.jhsa.2011.10.006

Jung, J. M., Baek, G. H., Kim, J. H., Lee, Y. H., & Chung, M. S. (2001). Changes in ulnar variance in relation to forearm rotation and grip. The Journal of Bone and Joint Surgery. British Volume, 83(7), 1029–1033. https://doi.org/10.1302/0301-620X.83B7.11062

Jung, K. J., Nho, J.-H., Kim, J. H., Kim, B.-S., & Gong, H. S. (2018). Triangular fibrocartilage complex repair and ulna variance: A systematic review. Journal of Hand Surgery (Asian-Pacific Volume), 23(3), 313–319. https://doi.org/10.1142/S2424835518300025

Koeyvoets, C. E. A., Teunissen, J. S., Feitz, R., Hovius, S., Hagert, E., & van der Heijden, E. P. A. (2023). Biomechanical outcomes of surgically repaired TFCC Palmer type 1B tears: A systematic review of cadaver studies. HAND, 18(8), 1258–1266. https://doi.org/10.1177/15589447221105546

Lee, J.-K., Lee, T.-C., Lee, S., Lim, H., Chang, E., Park, M. O., & Yao, J. (2026). Postoperative immobilization after foveal triangular fibrocartilage complex repair: A systematic review and meta-analysis of comparative studies. The Journal of Hand Surgery, 51(5), 512.e1–512.e11. https://doi.org/10.1016/j.jhsa.2026.01.029

Lee, S. W., Hong, J. J., Sung, S.-Y., Park, T.-H., & Kim, J.-S. (2024). Clinical outcomes and failure rate of triangular fibrocartilage complex foveal repair were comparable between arthroscopic and open techniques. Journal of Clinical Medicine, 13(10), Article 2766. https://doi.org/10.3390/jcm13102766

Lindau, T., Arner, M., & Hagberg, L. (1997). Intraarticular lesions in distal fractures of the radius in young adults: A descriptive arthroscopic study in 50 patients. Journal of Hand Surgery, 22(5), 638–643. https://doi.org/10.1016/S0266-7681(97)80364-6

Liu, E. H., Suen, K., Tham, S. K., & Ek, E. T. (2021). Surgical repair of triangular fibrocartilage complex tears: A systematic review. Journal of Wrist Surgery, 10(1), 70–83. https://doi.org/10.1055/s-0040-1718913

Mak, M. C. K., & Ho, P. C. (2024). Complications after arthroscopic triangular fibrocartilage complex (TFCC) surgery. Journal of Hand Surgery (European Volume), 49(2), 149–157. https://doi.org/10.1177/17531934231218608

McAdams, T. R., Swan, J., & Yao, J. (2009). Arthroscopic treatment of triangular fibrocartilage wrist injuries in the athlete. The American Journal of Sports Medicine, 37(2), 291–297. https://doi.org/10.1177/0363546508325921

McCarron, L., Bindra, R., Coombes, B. K., & Bisset, L. (2023). Wrist and forearm range of motion commencement time following primary triangular fibrocartilage complex foveal repair surgery: A scoping review. Journal of Hand Therapy, 36(1), 179–195. https://doi.org/10.1016/j.jht.2021.10.004

McCarron, L., Coombes, B. K., Bindra, R., & Bisset, L. (2024). Post-surgical rehabilitation guidelines for triangular fibrocartilage complex foveal repair: A survey of Australian hand and wrist surgeons. Journal of Hand Surgery (Asian-Pacific Volume), 29(4), 302–308. https://doi.org/10.1142/S2424835524500309

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

Meaike, J. D., Meaike, J. J., Amrami, K. K., & Kakar, S. (2024). Validating clinical distal radioulnar joint examination with radiographic parameters. HAND, 19(3), 442–447. https://doi.org/10.1177/15589447221124276

Minami, A., & Kato, H. (1998). Ulnar shortening for triangular fibrocartilage complex tears associated with ulnar positive variance. The Journal of Hand Surgery, 23(5), 904–908. https://doi.org/10.1016/S0363-5023(98)80171-8

Ou Yang, O., McCombe, D. B., Keating, C., Maloney, P. P., Berger, A. C., & Tham, S. K. Y. (2021). Ulnar-sided wrist pain: A prospective analysis of diagnostic clinical tests. ANZ Journal of Surgery, 91(10), 2159–2162. https://doi.org/10.1111/ans.17169

Palmer, A. K. (1989). Triangular fibrocartilage complex lesions: A classification. The Journal of Hand Surgery, 14(4), 594–606. https://doi.org/10.1016/0363-5023(89)90174-3

Pavić, R., Margetić, P., Benšić, M., Hnatešen, D., Kopljar, M., & Margetić, K. (2022). Comparative radiological diagnostics of acute triangular fibrocartilage complex injuries. Acta Clinica Croatica, 61(1), 129–137. https://doi.org/10.20471/acc.2022.61.01.16

Ryoo, H. J., Kim, Y. B., Kwak, D., Choi, I. C., & Park, J. W. (2023). Ulnar positive variance associated with TFCC foveal tear. Skeletal Radiology, 52(8), 1485–1491. https://doi.org/10.1007/s00256-023-04280-0

Sander, A. L., Sommer, K., Kaiser, A. K., Marzi, I., & Frank, J. (2021). Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint. European Journal of Trauma and Emergency Surgery, 47(5), 1621–1625. https://doi.org/10.1007/s00068-020-01315-2

Schmauss, D., Pöhlmann, S., Lohmeyer, J. A., Germann, G., Bickert, B., & Megerle, K. (2016). Clinical tests and magnetic resonance imaging have limited diagnostic value for triangular fibrocartilaginous complex lesions. Archives of Orthopaedic and Trauma Surgery, 136(6), 873–880. https://doi.org/10.1007/s00402-016-2441-9

Silber, Z. S., Donnelly, J. C., Farias, M. J., Lama, C. J., Luther, L. I., Kosinski, L. R., Hoy, A. E., & Gil, J. A. (2023). Return to activity after arthroscopically assisted triangular fibrocartilage complex repair: A systematic review. Clinical Journal of Sport Medicine, 33(3), 270–275. https://doi.org/10.1097/JSM.0000000000001114

Tse, Y. L.-F., Chau, W.-W., & Wong, C. W.-Y. (2023). A structured non-operative treatment program for traumatic triangular fibrocartilage complex tear: A quasi-experimental study. Hand Surgery and Rehabilitation, 42(6), 492–498. https://doi.org/10.1016/j.hansur.2023.07.009

van der Post, A. S., Jens, S., Daams, J. G., Obdeijn, M. C., Maas, M., & Oostra, R. J. (2022). The triangular fibrocartilage complex in the human wrist: A scoping review toward uniform and clinically relevant terminology. Clinical Anatomy, 35(5), 626–648. https://doi.org/10.1002/ca.23880

Xiao, J.-Y., Liu, B., Li, L., Shi, H.-F., & Wu, F. (2021). Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears. The Bone & Joint Journal, 103-B(8), 1386–1391. https://doi.org/10.1302/0301-620X.103B8.BJJ-2020-2310.R2

Yao, J., & Lee, A. T. (2011). All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. The Journal of Hand Surgery, 36(5), 836–842. https://doi.org/10.1016/j.jhsa.2011.01.005

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Published

2026-09-21

How to Cite

Trzciński, M., Chmielewska, Z., Lenkiewicz, J., Lenkiewicz, O., Kotłowska, A., Napiórkowska, W., Masłowska, A. I., Gwóźdź-Broczkowska, A., & Luba, G. (2026). CONTEMPORARY IMAGING, ARTHROSCOPIC REPAIR, AND FUNCTIONAL REHABILITATION IN TRAUMATIC TRIANGULAR FIBROCARTILAGE COMPLEX TEARS: A NARRATIVE REVIEW. International Journal of Innovative Technologies in Social Science, 4(3(51). https://doi.org/10.31435/ijitss.3(51).2026.6486

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