Radiographic and Clinical Outcomes of Ulnar Shortening Osteotomy with and without TFCC Foveal Repair in Ulnar Impaction Syndrome combined with TFCC foveal tear

Abstract Objectives To compare 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 presenting 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 (UV) were evaluated preoperatively and at 6 weeks, 6 months, 1 year, and 2 years postoperatively. Clinical outcomes, including VAS, Q-DASH, Mayo Wrist Score, and PRWE, 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 (UV) decreased in both groups postoperatively but remained stable in Group 2. Group 1 showed progressive UV increase with significant differences between groups at 6 months and 2 years (p < 0.05). Clinical scores improved in both groups with no significant intergroup differences. 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 a two-year period. Although these radiographic improvements did not correspond to significantly better clinical scores, restoration of distal radioulnar joint (DRUJ) stability through TFCC repair may contribute to improved long-term durability and functional outcomes following USO.