Arthroscopic Repair of Triangular Fibrocartilage Complex (TFCC)

The triangular fibrocartilage complex (TFCC) is the cartilage and ligament structure located in the ulnar (outer) side of the wrist, providing support and cushioning to the bones of the wrist. Since the TFCC is important in keeping the radius and ulna stable in grasping or rotational movements, a tear becomes both painful and limiting. Our Houston team is here to help.

Often, TFCC tears are caused by unanticipated pressure on the wrist or through a sports movement that suddenly jars the wrist or twists it into an awkward position. Sometimes the cause of injury is simply an everyday activity. You might be taking your suitcase from the overhead bin on an airplane. You grab it, and if the suitcase suddenly falls, you grip it harder so it does not land on someone else. The force of the weight at that speed pulls on the ligament and can tear it.

Diagnosis of TFCC is usually made through an MRI, though a hand specialist is often needed to detect the tear, since it is hard to visualize.

Not all tears are the same. To simplify, we divide them into two groups:

  • Acute: one that just occurred or is less than six weeks old
  • Chronic: characterized by persistent pain in the same region, going on for more than six weeks and unresolved with conservative treatment like rest, icing, splinting, and anti-inflammatories.

Acute tears that are minor are often treated conservatively and monitored for response. For most severe or chronic injuries, we recommend an arthroscopic repair procedure.

Arthroscopic Repair of TFCC Ligament

We have classified tears as acute or chronic. The location and extent, as well as the type of tissue torn (cartilage or ligament), will also vary, and will indicate whether suture repair is possible. Unlike most tissues, torn cartilage does not grow back together, so with TFCC tears that involve cartilage, the goal of surgery is to re-form the disk between the ulnar bones and wrist bones for stabilization. In these cases, sometimes the head of the ulna is also shaved down to avoid bone-on-bone contact.

If the ligament is all that is torn, however, suturing can be done so that the tissues grow back together.

The term “arthroscopic” refers to a scope that visualizes joint tissues and serves as a conduit for surgical instruments. In the arthroscopic repair of the TFCC, a small incision is made on the top side of the wrist near the joint, which protrudes from the wrist on the little finger side. Once the nature and extent of the tear is fully visualized, the surgeon will either stabilize the joint or repair the ligament in what is usually a 10-minute procedure. Scarring is minimal or non-existent and patients typically return to normal activities within three weeks.