J Hand Surg Am. 2026 Mar 11:S0363-5023(26)00143-7. doi: 10.1016/j.jhsa.2026.01.029. Online ahead of print.
ABSTRACT
PURPOSE: Foveal tears of the triangular fibrocartilage complex (TFCC) are a major cause of distal radioulnar joint instability and often require surgical repair to restore forearm function. Although foveal repair is increasingly performed, postoperative immobilization protocols remain variable and poorly standardized. This systematic review and meta-analysis evaluated the effects of different immobilization methods and durations on clinical outcomes after TFCC foveal repair.
METHODS: Comparative clinical studies assessing postoperative immobilization after TFCC foveal repair were identified through a systematic review of MEDLINE, EMBASE, Web of Science, and the Cochrane Library. Outcomes included pain (visual analog scale), Disabilities of the Arm, Shoulder and Hand scores, wrist range of motion, grip strength, and complications. For quantitative analysis, studies were grouped according to immobilization method: elbow-restricted immobilization versus forearm-restricted immobilization permitting elbow motion. Studies evaluating immobilization duration or timing of motion initiation were analyzed descriptively.
RESULTS: Five comparative studies (288 patients) met the inclusion criteria; four evaluated immobilization methods, and 2 assessed immobilization duration or initiation of forearm rotation. Three studies were included in the meta-analysis. No significant differences were found between elbow-restricted and forearm-restricted immobilization in final pain visual analog scale (mean difference [MD] -0.34; 95% CI, -0.91 to 0.24), Disabilities of the Arm, Shoulder and Hand scores (MD -1.67; 95% CI, -6.71 to 3.38), grip strength (MD +0.38%; 95% CI, -9.69 to 10.45), or wrist range of motion, and complication rates were similarly low across groups. Studies investigating immobilization duration demonstrated that restricting pronation and supination for approximately 4-6 weeks yielded better pain relief and functional recovery than immediate rotation, without causing persistent elbow stiffness.
CONCLUSIONS: Based on currently available comparative studies, postoperative immobilization after TFCC foveal repair may benefit more from restricting forearm rotation than from restricting elbow motion. Additional restriction of elbow flexion and extension has not shown a consistent advantage in reported outcomes, whereas delaying forearm pronation and supination for up to 6 weeks may help protect the repair while still permitting early functional recovery. Further studies are needed to establish standardized guidelines.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
PMID:41811284 | DOI:10.1016/j.jhsa.2026.01.029
