Need for Secondary Ulnar Shortening Osteotomy after Arthroscopic TFCC Debridement/Repair in Patients with Ulnar Positive Variance

Abstract Although studies have suggested a negative effect of positive ulnar variance on outcomes after adequate arthroscopic triangular fibrocartilage complex (TFCC) management, the exact clinical impact of ulnar positive variance remains inconclusive. The purpose of this study was to determine the rate of subsequent ulnar shortening osteotomy (USO) after arthroscopic management of TFCC pathology in ulnar-positive wrists and to identify factors associated with progression to USO. This retrospective cohort study included 150 wrists with positive ulnar variance that underwent arthroscopic TFCC debridement or repair by a single surgeon between 2005 and 2025 after application of the exclusion criteria. Patients were stratified based on whether secondary USO was performed during follow-up. Baseline demographics, radiographic ulnar variance, index arthroscopic procedure type, and adjunct procedures were compared between groups. Univariable logistic regression was performed to explore factors associated with subsequent USO. The mean preoperative ulnar variance was 1.74 ± 0.77 mm (range, 0.5–4.0 mm). Arthroscopic repair was performed in 90 wrists (60%) and debridement in 60 wrists (40%). During follow-up, 12 wrists (8%) underwent secondary USO at a median of 8.2 months after index arthroscopy. Baseline demographics, the degree of ulnar variance, and the index arthroscopic procedure type were not associated with progression to USO. In contrast, full-thickness lunate chondral defects requiring microfracture at the index arthroscopy were more common in wrists that later underwent USO than in those that did not (25% vs. 3.6%; p = 0.018). In univariable regression analysis, lunate microfracture was associated with subsequent USO, although this finding should be interpreted cautiously given the small number of events. Among ulnar-positive wrists treated arthroscopically for TFCC pathology, the observed proportion of subsequent USO was 8%. Baseline demographics and the degree of ulnar variance were not associated with progression to USO. Full-thickness lunate chondral defects requiring microfracture at the index arthroscopy were more frequently observed in wrists that later underwent USO. IV, therapeutic study.