Predictive Factors for Patient Recovery Following Triangular Fibrocartilage Foveal Repair Surgery: A Retrospective Case-Series

TL;DR

This study identifies factors affecting recovery after triangular fibrocartilage repair surgery, finding that longer forearm immobilization and work-related injuries are linked to worse outcomes.

Contribution

The study provides new insights into predictive factors for recovery outcomes after TFCC foveal repair surgery.

Findings

Longer forearm immobilization predicted poorer range of motion and grip strength progression.

Shorter wrist immobilization increased the risk of TFCC rupture.

Workcover patients showed worse range of motion progression compared to private patients.

Abstract

There are many factors that may influence patient recovery following triangular fibrocartilage complex (TFCC) foveal repair surgery. This study aimed to retrospectively analyze patient records following TFCC foveal repair surgery to identify characteristics that predict patient outcomes.

A multicenter, retrospective case-series was conducted. Informed written consent was obtained from participating hand therapy clinics, who provided deidentified patient records for adult patients following TFCC foveal repair surgery between January 1 2015 and December 31 2020. Predictors of outcomes were identified using Linear Mixed Effects Regression and Logistic Regression models.

A total of 210 patients were included. The most notable improvements in range of motion (ROM) and grip strength, and pain reduction, were observed in the first 10 weeks postsurgery. Longer forearm immobilization duration predicted poorer ROM for pronation, flexion, and extension. Workcover (compensable) patients demonstrated poorer ROM progression compared with private patients. Forty-two patients (20%) required further surgery, of which was due to postoperative TFCC rupture for 22 patients (10%). Patients who received a shorter wrist immobilization period were more likely to experience TFCC rupture. The duration of time between injury and operative treatment did not predict ROM, grip strength, or pain progression.

Longer forearm immobilization predicted poorer ROM and grip strength progression, whereas shorter wrist immobilization predicted an increased risk of TFCC rupture. These findings support a staggered commencement of wrist and forearm ROM exercises, whereby forearm rotation exercises could commence earlier than wrist exercises. The duration of time between injury and operative treatment did not predict ROM, grip strength, or pain progression.

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