Combined Transosseous and Capsular Repair Improves Grip Strength in Triangular Fibrocartilage Complex Tears: A Randomized Controlled Trial.

PURPOSE: To compare the clinical outcomes of arthroscopically assisted transosseous repair versus combined transosseous and capsular repair for triangular fibrocartilage complex tears in patients with distal radioulnar joint (DRUJ) instability.

METHODS

Patients treated for triangular fibrocartilage complex injuries (Atzei class 2) causing DRUJ instability between September 2020 and September 2022 were prospectively randomized into 2 treatment groups based on the surgical approach: Group A underwent transosseous repair (n = 20), whereas group B underwent combined transosseous and capsular repair (n = 20). Preoperative and postoperative follow-up data of patients were recorded, including DRUJ stability; visual analog scale score; Disabilities of the Arm, Shoulder and Hand score; Modified Mayo Wrist Score (MMWS); wrist range of motion (ROM; flexion and extension, ulnar-radial deviation, and forearm rotation); and grip strength ratio (compared with the contralateral side). Complications were recorded.

RESULTS

Forty participants were enrolled in this prospective randomized controlled trial. All patients completed the mandated minimum 24-month follow-up (median, 36 months; range, 24-48 months). Concerning grip strength recovery, group B (94.2% ± 4.2%) had significantly better outcomes than group A (84.2% ± 4.3%, P < .001). Clinically meaningful improvements were observed in the grip strength ratio (100%). Group B showed superior grip strength recovery (P < .001). Regarding DRUJ stability grades, group B included 15 patients with grade 0 and 5 with grade 1 whereas group A included 10 patients with grade 0 and 10 with grade 1 (P = .102). No statistically significant differences in wrist flexion-extension, forearm rotation, and ulnar-radial deviation were observed between groups A and B (P > .05 for all comparisons). The differences in visual analog scale score, Disabilities of the Arm, Shoulder and Hand score, and MMWS were not statistically significant (all P > .05).

CONCLUSIONS

Arthroscopy-assisted transosseous repair with capsular augmentation showed significantly superior grip strength recovery compared with transosseous repair alone; both techniques achieved significant improvements in postoperative functional outcomes, pain reduction, MMWS, and wrist ROM.

LEVEL OF EVIDENCE: Level Ⅰ, randomized controlled trial.