Postoperative Immobilization After Foveal Triangular Fibrocartilage Complex Repair: A Systematic Review and Meta-Analysis of Studies

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, post operative 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.<br /> 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 immo bilization method: elbow-restricted immobilization versus forearm-restricted immobilization permitting elbow motion. Studies evaluating immobilization duration or timing of motion initiation were analyzed descriptively.<br /> 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.<br /> Conclusions Based on currently available comparative studies, postoperative immobilization after TFCC foveal repair may benefit more from restricting forearm rotation than from testricting 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 bermitting early functional recovery. Further studies are needed to establish standardized guidelines. (J Hand Surg Am. 2026;51(5):512.e1-e11. Copyright (c) 2026 by the American Society for Surgery of the Hand. All rights are reserved, including those for text and data mining, Al training, and similar technologies.<br /> Type of study/level of evidence Therapeutic III.