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.