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J Wrist Surg
DOI: 10.1055/a-2793-0911
Survey or Meta-Analysis

Arthroscopic versus Open TFCC Repair: A Systematic Review and Network Meta-analysis

Authors

  • Eric Ansong 

    1   Trauma and Orthopaedic Department, University Hospitals Sussex NHS Foundation Trust, Brighton and Sussex University Hospital, Sussex, United Kingdom

  • Nathan Mitchell 

    2   Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, United Kingdom

  • Gagandeep Mahi 

    3   Trauma and Orthopaedics Department, Northampton General Hospital, Northampton, United Kingdom

  • Chan Khin 

    1   Trauma and Orthopaedic Department, University Hospitals Sussex NHS Foundation Trust, Brighton and Sussex University Hospital, Sussex, United Kingdom

  • Olive Kyaw 

    1   Trauma and Orthopaedic Department, University Hospitals Sussex NHS Foundation Trust, Brighton and Sussex University Hospital, Sussex, United Kingdom

  • Julian Robinson

    4   University Hospitals Sussex NHS Foundation Trust, St Richard's Hospital, Chichester, United Kingdom

  • Han Hong Chong 

    5   Trauma and Orthopaedics Department, Calderdale and Huddersfield NHS Foundation Trust (CHFT), United Kingdom
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Abstract

Background

Triangular fibrocartilage complex (TFCC) tears cause ulnar-sided wrist pain and may contribute to distal radioulnar joint (DRUJ) instability. Although both arthroscopic and open repair techniques are utilized, their comparative effectiveness regarding patient-reported outcomes, pain relief, functional recovery, and complication rates remains unclear.

Methods

We conducted a systematic review and network meta-analysis following PRISMA 2020. We searched multiple databases from inception to January 2025 for studies reporting clinical outcomes after arthroscopic or open TFCC repair in adults. Five reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I. Patient-reported outcome measures (PROMs), pain scores, range of motion, grip strength, and complications were collated and assessed. Frequentist network meta-analysis produced pooled mean differences (MDs) and risk ratios (RRs) each with corresponding 95% confidence intervals (CIs).

Results

A total of 13 studies (n ≈ 800) met inclusion criteria. Both approaches demonstrated substantial clinical improvements in PROM: arthroscopic MD −26.2 (95% CI −30.5 to −21.9) and open repair MD −27.3 (95% CI −34.1 to −20.4). Indirect comparison revealed no significant difference between approaches (MD −1.01, 95% CI −9.08 to 7.05). Pain reduction favored arthroscopy numerically but was not statistically significant. Revision rates were low in both groups, with a non-significant trend favoring arthroscopy. Complication rates were lower with arthroscopic techniques, primarily due to fewer superficial wound and sensory branch-related issues.

Conclusions

Both arthroscopic and open TFCC repairs provide clinically meaningful improvements in pain and function. High-quality prospective comparative studies are needed to provide definitive guidance.

Level of evidence

III.

Keywords

TFCC - arthroscopic repair - open repair - systematic review - meta-analysis

Contributors' Statement

J.R.: performed the literature search; E.A., N.M., G.M., C.K., O.K., and H.H.C.: involved in protocol development, literature review, data analysis, and wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.




Publication History

Received: 19 November 2025

Accepted: 18 January 2026

Article published online:
12 February 2026

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