Management of Ulnar Wrist Pain Without Ulnar Plus Variance: A Comparative Study of Arthroscopic Triangular Fibrocartilage Complex Repair and Ulnar Shortening Osteotomy

<b>Background:</b> Managing ulnar wrist pain without ulnar plus variance presents a clinical challenge. This study aimed to compare the causes of symptom onset and surgical outcomes between arthroscopic triangular fibrocartilage complex (TFCC) repair and ulnar shortening osteotomy (USO) and analyse factors influencing pain reduction following arthroscopic TFCC repair. <b>Methods:</b> Twenty-four patients without ulnar plus variance who underwent either arthroscopic TFCC repair or USO at our institution were retrospectively reviewed. Demographic data, symptom onset causes, time from onset to surgery, pre- and postoperative range of motion (ROM), grip strength ratio (injured to uninjured wrist), numeric pain rating scale (NRS), change in NRS and Hand20 scores were compared between the two treatment groups. For TFCC repair, correlations were investigated between NRS change and time from onset to surgery and between NRS change and age. <b>Results:</b> Of 24 patients, 14 underwent arthroscopic TFCC repair and 10 underwent USO. Only two patients in the USO group had no clear onset trigger, whereas most had identifiable triggers. Both groups showed no significant differences in pre- and postoperative ROM, grip strength ratio, NRS and Hand20 score. The change in NRS was significantly greater in the USO group (<i>p</i> = 0.049). For the TFCC repair group, NRS change was significantly negatively correlated with age (Spearman's rank correlation coefficient -0.603, <i>p</i> = 0.029). <b>Conclusions:</b> Our findings indicate that patients without ulnar plus variance who experience symptom onset including trauma often have an underlying degenerative component as well as instability. USO provides significant pain relief in such cases. Arthroscopic TFCC repair was effective in young patients in whom instability was the primary cause of pain and age was associated with pain reduction rather than time from onset to surgery. Effective treatment strategies for ulnar wrist pain without ulnar plus variance should consider both age and wrist arthroscopy findings to optimise outcomes. <b>Level of Evidence:</b> Level IV (Therapeutic).