Open versus arthroscopic triangular fibrocartilage repairs: a narrative review

Background The triangular fibrocartilage complex (TFCC) stabilizes the distal radioulnar joint (DRUJ) and transmits load across the wrist. While many injuries respond to conservative care, certain tear patterns require surgery. Open and arthroscopic repairs are both used, but the optimal approach is debated. Arthroscopy offers minimally invasive access, assessment of concomitant injuries, and faster early recovery, whereas open repair is traditionally preferred for complex or foveal tears. Despite comparable outcomes, the optimal technique remains uncertain. Objectives This narrative review compares open and arthroscopic TFCC repair, focusing on indications, techniques, complications, and evolving strategies to guide clinical decision-making. Methods A non-systematic search of PubMed, Embase, and Scopus (2005–2025) was performed. Key studies on open and arthroscopic TFCC repair were reviewed and synthesized. Results Both open and arthroscopic repairs yield similar mid-term patient-reported outcomes. Arthroscopic repair may permit earlier recovery and carries a slightly lower soft-tissue complication risk. Open repair offers direct visualization and is advantageous for complex or foveal lesions. No clear differences in DRUJ stability, functional scores, or return-to-activity times were identified, though available data remain limited. Complication profiles vary between techniques. Conclusion Open and arthroscopic TFCC repairs provide reliable results, with neither demonstrating overall superiority. Technique selection should be individualized based on tear pattern, DRUJ stability, and patient factors. Advances in arthroscopy and biologic augmentation may enhance outcomes, but high-quality comparative studies are needed to define optimal management.