Radiographic and clinical outcomes of ulnar shortening osteotomy with and without triangular fibrocartilage complex (TFCC) foveal repair in ulnar impaction syndrome combined with TFCC foveal tear: a retrospective comparative cohort study

Purpose: This study aimed to compare the radiographic and clinical outcomes of ulnar shortening osteotomy (USO) alone versus USO combined with arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) in patients with ulnar impaction syndrome (UIS) and TFCC foveal tears.Methods: Eighteen patients with UIS and TFCC foveal tears who presented with lunate chondral lesions on preoperative radiographs were retrospectively reviewed. Group 1 (n=9) underwent USO alone, and group 2 (n=9) received USO with arthroscopic TFCC repair. Lunate chondral lesion size and ulnar variance were evaluated preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Clinical outcomes, including the visual analog scale, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, Mayo Wrist Score, and Patient-Rated Wrist Evaluation, were assessed serially.Results: Both groups demonstrated progressive postoperative healing of lunate chondral lesions. However, group 2 exhibited significantly faster reduction in lesion size. Ulnar variance decreased in both groups postoperatively but remained stable in group 2. Group 1 showed a progressive increase in ulnar variance, with significant differences between groups at 6 months and 2 years (p<0.05). Clinical scores improved in both groups, but no significant intergroup differences were observed.Conclusion: USO combined with arthroscopic TFCC foveal repair resulted in superior radiographic outcomes compared to USO alone, demonstrating more consistent healing of lunate chondral lesions and sustained correction of ulnar variance over 2 years. Although these radiographic improvements did not correspond to significantly better clinical scores, restoring distal radioulnar joint stability through TFCC repair may contribute to improved long-term durability and functional outcomes after USO.