Clinical outcomes of arthroscopic treatment for triangular fibrocartilage complex lesions in adolescent elite athletes

Key points

1. 01Pain scores dropped from 6.9 to 0.6 out of 10 at 6 months after surgery
2. 02Grip strength increased from 26.3 kg to 40.8 kg
3. 03Wrist flexion, extension, and pronosupination all improved significantly
4. 04DASH disability scores fell from 45.1 to 6.0, indicating near-normal upper limb function
5. 05All 24 athletes returned to their prior sport level with no major complications

How it was conducted

Design

Retrospective case series

Participants

24 adolescent elite athletes, mean age 15.5 years (range 13-18), 9 male and 15 female

Intervention

Wrist arthroscopy with outside-inside peripheral TFCC repair using polydioxanone sutures, followed by structured rehabilitation

Primary outcomes

NRS pain, grip strength, wrist ROM (flexion, extension, pronosupination), DASH score, and clinical provocation tests at 6 months

Indication

Traumatic peripheral TFCC tears unresponsive to at least 6 months of conservative treatment

Sports represented

Tennis (6), kickboxing (4), volleyball (4), boxing (2), soccer (2), and others

What they found

• NRS pain decreased from 6.9 +/- 1.2 to 0.6 +/- 0.7 (p < 0.001, t = 25.76)
• Grip strength increased from 26.3 +/- 6.9 kg to 40.8 +/- 5.6 kg (p < 0.001, t = -25.78)
• Wrist flexion ROM improved from 71.5 +/- 8.0 degrees to 87.7 +/- 4.7 degrees (p < 0.001, t = -10.43)
• Wrist extension ROM improved from 64.9 +/- 8.0 degrees to 82.6 +/- 6.9 degrees (p < 0.001, t = -10.26)
• Pronosupination ROM improved from 132.2 +/- 18.2 degrees to 175.5 +/- 5.1 degrees (p < 0.001, t = -14.10)
• DASH score decreased from 45.1 +/- 4.4 to 6.0 +/- 2.2 (p < 0.001, t = 42.74)
• Ballottement test positive cases decreased from 24/24 to 4/24 (chi-square 34.29, p < 0.001)
• Waiter's test positive cases decreased from 19/24 to 3/24 (chi-square 21.48, p < 0.001)
• Piano key test positive cases decreased from 20/24 to 5/24 (chi-square 18.78, p < 0.001)
• 2 minor complications (extensor carpi ulnaris tenosynovitis, suture-site skin discomfort), both resolved spontaneously; no major complications

Limitations

• Retrospective single-center design with no control group, preventing conclusions about superiority over other treatments
• Small sample of 24 patients limits statistical power and generalizability
• Follow-up limited to 6 months, so long-term durability and recurrence rates are unknown
• Surgeons who performed operations also conducted postoperative assessments with no blinding, introducing observer bias

Why it matters

For patients

An adolescent athlete with a wrist TFCC tear that has not improved with 6 months of conservative care can expect substantial pain relief and return to full sport after arthroscopic repair, typically within 3 months of surgery.

For clinicians

Arthroscopic outside-inside peripheral TFCC repair is a safe, minimally invasive option for adolescent elite athletes; the outside-inside suture technique avoids transosseous tunnels that could injure open physes.

For readers

This is the first study reporting arthroscopic TFCC repair outcomes specifically in adolescent elite athletes, showing strong short-term results, but the small retrospective design and absence of a comparison group mean findings should be interpreted with caution.