Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance.

Because a certain percentage of patients with positive ulnar variance experience incomplete pain relief after triangular fibrocartilage complex (TFCC) debridement alone, we prospectively evaluated the feasibility and efficacy of combining arthroscopic TFCC debridement with arthroscopic wafer resection in such wrists as part of the same surgical procedure. We enrolled 12 patients between July 1998 and July 2000 and performed both subjective and objective assessment at follow-up with a minimum of 6 months and an average of 14 months. Seven posttraumatic and 5 degenerative tears were identified. Preoperative ulnar variance with a pronated grip x-ray averaged 2 mm and ranged between 1 and 4 mm. At final review 8 patients experienced complete pain relief and 4 experienced only minimal symptoms. The ulnocarpal stress test failed to elicit pain in any wrist. Nine patients were very satisfied, and 3 were satisfied. Grip strength improved 8 kg (36%). This procedure should be considered in the treatment of ulnar wrist pain when TFCC tears and positive ulnar variance coexist.