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

Abstract 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. 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). 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. 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. III.