Person:

Wu, Mark

Purpose: To investigate the clinical results and patient-reported functional outcomes following surgical treatment for TFCC tears in the pediatric and adolescent population. Methods: We reviewed 149 patients with 153 arthroscopy-confirmed TFCC tears. Mean age at surgery was 15.5 years (range,7-19). There were 86 females. Plain radiographs and magnetic resonance imaging (MRI) were used to characterize bony and soft-tissue pathology. Mayo Modified Wrist Score (MMWS) and PROMIS® Upper Extremity Short Form assessed functional outcomes. Median follow-up was 21.8 months (IQR:5.9-55.4). Results: Pre-operatively, all patients had wrist pain or instability with activities. Median pre-operative MMWS was 80(IQR:65-90). Forty-nine(32%) presented with positive ulnar variance. Concomitant pathology included DRUJ instability(14%), ulnocarpal impaction(20%), ulnar styloid non-union(32%), and distal radius growth arrest(30%). On arthroscopy, there were 15 (10%) isolated 1A, 79 (52%) 1B, 1 (1%) 1C, 30 (20%) 1D tears, and 25 (16%) cases of multiple tears. Twenty-six percent of wrists underwent TFCC debridement, 68% arthroscopic-assisted repair, 6% both for combined tears. To achieve neutral ulnar variance, 51% of wrists underwent bony procedures. – most commonly ulnar shortening osteotomy(40%) and ulnar styloid non-union excision(39%). At final follow-up, pain, wrist ROM, DRUJ stability, ulnar variance, and MMWS [median:95 (IQR 86.5-100)] improved significantly. The median PROMIS T-score at final follow-up was 57(IQR: 45-57). MMWS was better in those with concomitant bony procedure at index surgery than those with only repair or debridement of TFCC tears (p=.01). There was no difference in outcomes between tear types or between treatment with repair or debridement. Conclusion: Most pediatric TFCC tears are post-traumatic, peripheral, and cause pain during activity. Surgical treatment of TFCC tears results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. Addressing concomitant pathology is important to maximize outcomes.