Abstract
Introduction and Importance:
Triangular fibrocartilage complex (TFCC) tears can significantly impair wrist stability and daily function. Regenerative medicine, particularly mesenchymal stem cell-based therapy, may complement traditional surgical approaches such as debridement with synovectomy to enhance recovery.
Presentation of Case:
This report presents the 1-year follow-up of a 41-year-old male with a TFCC tear previously treated with debridement synovectomy followed by intra-articular umbilical cord-derived mesenchymal stem cells (UC-MSCs) and UC-MSC-derived secretome. UC-MSCs were selected for their regenerative potential and well-established roles in tissue repair. Clinical evaluations were performed pretreatment, at 6 months, and at 12 months. Outcomes were assessed using magnetic resonance imaging (MRI), the Visual Analogue Scale (VAS), and the Disabilities of the Arm, Shoulder and Hand (DASH) score. At 12 months, the patient maintained a VAS score of 0, indicating complete and sustained pain resolution. Functional improvement continued, with the DASH score progressing from 12 at 6 months to 5.8 at 12 months. MRI findings demonstrated stable postoperative healing without recurrent injury or degenerative change.
Clinical Discussion:
One-year follow-up shows near-complete restoration of daily wrist function. No adverse events related to UC-MSC or secretome administration occurred. These results suggest that UC-MSC-based therapy may provide durable regenerative benefits when used as an adjuvant to debridement with synovectomy.
Conclusion:
One year after surgery supplemented with UC-MSC and secretome therapy, the patient demonstrates sustained pain relief and progressive functional recovery. This case supports the potential role of UC-MSC-based therapy in enhancing long-term outcomes in TFCC injury, warranting further investigation.
Keywords: adjuvant regenerative therapy, case report, pain and functional recovery, secretome, triangular fibrocartilage complex (TFCC) tear, umbilical cord-derived mesenchymal stem cells (UC-MSCs)
Introduction
The triangular fibrocartilage complex (TFCC) is a structure in the wrist joint located between the lunate, triquetrum, and ulnar aspect of the distal, which works as a stabilizer for the distal radioulnar joint. Studies show that TFCC injuries become more common with age. One study reported a 49% prevalence in patients over 70 compared with 27% in those 30 or younger. Another study found a similar rate in younger patients and noted that TFCC injuries occurred just as often in people without ulnar-sided wrist pain[1]. The TFCC structure comprises the articular disc, meniscal homologue, radioulnar ligament, and the sheath of the extensor carpi ulnaris (ECU) tendon. Injuries to the TFCC can occur with tears in the articular disc and meniscal homologue, typically resulting in pain on the ulnar aspect of the wrist[2]. Additional symptoms may include swelling and a limited range of motion, which can interfere with daily activities. TFCC tears can be classified into two types, traumatic and degenerative. Traumatic TFCC injuries are often caused by repetitive wrist movements during physical activities, while degenerative tears are typically associated with aging[3]. TFCC tears frequently result from activities involving excessive and repetitive wrist motion. These injuries are commonly accompanied by ulnar-sided wrist pain, joint clicking, and decreased range of motion[4].
HIGHLIGHTS
This case is among the first to report umbilical cord mesenchymal stem cells (UC-MSCs) and their secretome as adjuvant therapy for triangular fibrocartilage complex (TFCC) tear.
Complete pain relief (VAS 0) was maintained for 12 months post-treatment, functional outcomes continued to improve, with the DASH score decreasing from 12 to 5.8, and MRI at 12 months confirmed stable TFCC healing without reinjury or degenerative changes.
No adverse events were observed, supporting the safety and long-term regenerative potential of UC-MSC-based therapy.
Diagnosis of TFCC injuries involves clinical evaluation supported by imaging modalities such as magnetic resonance imaging (MRI), which can identify the extent of the tear. However, wrist arthroscopy remains the gold standard for definitive diagnosis and treatment. Traditional management strategies include conservative measures such as rest, splinting, and physical therapy, though these measures may not always be effective. If conservative treatment fails, surgical options such as arthroscopic repair or debridement may be indicated[5]
Recent advances in regenerative medicine have introduced the use of mesenchymal stem cells (MSCs) and their secretome as promising therapeutic options for TFCC injuries. MSCs exhibit regenerative capabilities by promoting tissue repair and exerting anti-inflammatory effects[6–8]. Among various sources, umbilical cord mesenchymal stem cells (UC-MSCs) have shown significant potential in orthopedics due to their accessibility, abundance, and minimal ethical concern[9].
This case report describes the treatment of a TFCC tear in a 41-year-old male patient using UC-MSCs and their secretome, with pain levels monitored using the Visual Analog Scale (VAS). Although UC-MSCs have been explored in broader orthopedic contexts[10–12] scientific publications specifically addressing their application in TFCC tears remain limited. Therefore, further evidence is needed to validate their regenerative potential in treating cartilage injuries such as TFCC. To ensure methodological rigor and clear clinical relevance, this case report has been prepared and reported in accordance with the SCARE checklist[13].
Case presentation
The patient is a 41-year-old male weighing 47 kilograms (BMI 18.59), presenting with progressive pain and intermittent swelling localized on the ulnar side of the right wrist. Patient works as an IT staff at a private bank and is right-hand dominant. The patient has no known drug allergies, and there is no significant family history or relatives with similar conditions. At presentation, the symptoms were first interpreted as a mild sprain or routine inflammatory process. Tendinitis of the ECU was included in the initial differential diagnosis alongside a potential TFCC tear. The patient underwent arthroscopy to evaluate potential intra-articular abnormalities. The patient then diagnosed with a TFCC tear based on clinical symptoms and MRI findings, which revealed partial tears in the upper and lower triangular lamina, along with UMH injury. Even with initial arthroscopic debridement and synovectomy, the patient’s pain and functional impairments persisted.
Baseline laboratory investigations (complete blood count, erythrocyte sedimentation rate) were within normal limits, indicating no active infection or systemic inflammatory disease. To obtain a more comprehensive assessment, MRI provides a more thorough evaluation. The MRI results showed no abnormalities in bone alignment or structure, intact joint spaces, no evidence of fractures, preserved tendon integrity, and normal muscle architecture. However, notable findings included evidence of bone marrow edema within the periarticular region of the distal ulnar bone, the lunotriquetral ligament structure was not visualized, a tear involving the proximal and distal lamina of the triangular fibrocartilage, and injury to the ulnomeniscal homologue (UMH). These findings are consistent with a TFCC tear, which was likely the primary contributor to the patient’s persistent wrist pain and functional impairment.
After thorough discussion about potential benefits, risks, and costs, the patient consented to undergo regenerative therapy as an adjunct to surgical management. The patient underwent arthroscopic debridement and synovectomy, performed by an experienced orthopedic surgeon specializing in hand and wrist surgery (>10 years of microsurgical experience). No repairable TFCC structure was identified intraoperatively, confirming the lesion as unrepairable, which supported the indication for debridement rather than reconstruction. Over the following months, the patient was thoroughly informed about the nature of the injury and the available treatment options. After informed consent, the patient received intra-articular injections of umbilical cord-derived mesenchymal stem cells (UC-MSCs) and UC-MSC-derived secretome therapy as an adjuvant treatment option after extensive conversations regarding the nature of the injury and a review of possible treatment approaches. Given that this represents the first application of this specific procedure in humans, the decision was supported by a substantial body of preclinical and clinical evidence demonstrating the safety and therapeutic potential of MSC-based interventions in orthopedic medicine. A detailed timeline of events is provided in Table 1.
Table 1.
Timeline of events.
| Events | Date |
|---|---|
| MRI before debridement synovectomy. | 28/01/2024 |
| Debridement synovectomy | 18/01/2024 |
| First injection (secretome) | 30/01/2024 |
| Second injection (UC-MSCs & secretome) | 06/02/2024 |
| 1-month post-injection observation | 06/03/2024 |
| 3-month post-injection observation | 06/05/2024 |
| 6-month post-injection observation | 06/08/2024 |
| 12-month post-injection observation | 06/02/2025 |
The patient subsequently received intra-articular injection treatments using UC-MSC-derived secretome and a combination of UC-MSCs with their secretome. The treatment protocol involved two intra-articular injections administered at a 1-week interval. The first injection consisted of 5 cc of USEPro® (Umbilical Cord Secretome ProSTEM). The second injection included a combination of 1 cc of USEPro and 20 million cells of MeSCPro® (Mesenchymal Stem Cells ProSTEM) in 4 cc of NaCl. Administration considerations included aseptic technique, pre-procedural local anesthesia, and post-injection observation for any immediate adverse reactions. The patient was advised to limit heavy wrist activity for 2 weeks post-procedure.
Follow-up assessments were conducted at 1 month, 3 months, 6 months, and 12 months post-injections to evaluate the therapeutic effects. Clinical evaluations included physical examinations with a focus on the Visual Analog Scale (VAS) as the primary outcome measure for pain reduction. The VAS score was recorded at multiple time points: before the injection, at 1 month, 3 months, and 6 months post-treatment. Additionally, the Disabilities of the Arm, Shoulder and Hand (DASH) score was used to assess upper limb function at two time points: pre-injection and 12 month post-injection. This approach allowed for a comprehensive assessment of pain reduction over time, while the DASH score provided insights into the improvement in functional status following the UC-MSCs and their secretome therapy.
Outcomes
After 1 month, the patient reported significant pain reduction from a VAS score of 7 to 3, alongside improvements in functional hand activities such as gripping and lifting. The VAS is a validated patient-reported tool for assessing pain intensity on a continuous scale from 0 (“no pain”) to 10 (“worst imaginable pain”)[14]. Additionally, there was a marked decrease in wrist joint crepitus, indicating a reduction in mechanical dysfunction. At the 3-month follow-up, further improvements in pain relief were observed (VAS score 3 to 2), with continued reduction in VAS scores, coupled with increased hand strength and range of motion. By the 6-month evaluation, the patient experienced sustained pain relief, with near-complete resolution of wrist pain and improved function. These findings support the synergistic effect of combining UC-MSCs and their secretome with standard arthroscopic treatment in promoting tissue repair and functional recovery. No adverse events were observed throughout 12 months of follow-up, confirming the safety of allogeneic UC-MSC and secretome therapy for this indication.
The DASH score, which evaluates the patient’s upper limb function and disability, demonstrated significant improvement during the treatment period. The DASH is a 30-item disability/symptom scale ranging 0 (no disability) to 100 (maximum disability)[15]. Initially, the patient had a DASH score of 51, which falls under the “Poor” classification, indicating a substantial degree of disability and functional impairment. By 6 months following the injection, the patient’s DASH score improved to 12, falling into “Good” classification, further to 5.8 (excellent) at 12 months, reflecting nearly complete functional recovery, indicating a significant improvement in upper limb function and a decrease in impairment. This improvement highlights the positive impact of the treatment on the patient’s overall functional status.
At 6 months post-injection, MRI showed intact bone alignment of the distal radio-ulnar and carpal bones, with no dislocation or deformity. The cartilage remained regular, and ligaments appeared intact. Only mild pisotriquetral effusion and subcutaneous edema were observed, without cystic or ganglion formation. These findings indicate partial healing and stabilization of the chronic TFCC and UMH injury.
At 12 months post-injection, MRI demonstrated stable postoperative healing of the TFCC region, intact ligaments, and no degenerative progression. The absence of marrow edema and recurrent injury correlated with the sustained clinical recovery. These findings correlate with the clinical improvement observed with VAS and DASH scores presented in Tables 2 and 3, supporting the effectiveness of the treatment in reducing symptoms and promoting functional recovery. However, the mild subcutaneous edema suggests that further monitoring may be necessary.
Table 2.
VAS score for pain assessment pre- and post-injection.
| Time point | VAS score |
|---|---|
| Pre-injection | 7 |
| 1 month post-injection | 3 |
| 3 months post-injection | 2 |
| 6 months post-injection | 0 |
| 12 months post-injection | 0 |
Table 3.
DASH scores pre- and post-injection.
| Time point | DASH score |
|---|---|
| Pre-injection | 51 |
| 6 months post-injection | 12 |
| 12 months post-injection | 5,8 |
We also analyzed the synovial fluid to confirm any cellular abnormalities and assess potential inflammatory or degenerative changes. The examination was performed to check for the presence of abnormal cell components after the administration of UC-MSCs and their secretome.
The synovial fluid analysis was conducted only at 12-months post-injection, as there was insufficient synovial fluid available for testing prior to the treatment. The result showed no signs of abnormal cells, as summarized in Table 4. However, due to the limited volume of synovial fluid available, the sample had to be diluted with 2 cc of distilled water before re-aspiration, which may have impacted the accuracy of the analysis. Despite this limitation, no abnormalities were detected, indicating that the treatment did not result in any inflammatory or adverse cellular reactions.
Table 4.
Synovial fluid analysis at 12 months post-injection.
| Laboratory Test | Result | Units | Interval ranges |
|---|---|---|---|
| Immunology | |||
| Body fluid test (synovial) | |||
| Color | White | ||
| Clarity | Clear | ||
| Viscosity | 4 | cm | [4–6] |
| Spontaneous clotting | Negative | [Negative] | |
| Leukocyte | 8 | cell/µL | [≤200] |
| PMN cell | 25 | % | [≤25] |
| MN cell | 75 | % | [≤75] |
| Erythrocytes | 2000 | cells/µL | |
| Glucose serum | Pending | mg/dL | [70–100] |
| Glucose synovial | 9 | mg/dL | |
| Glucose difference | Pending | mg/dL | [≤10] |
| Protein synovial | 0 | g/dL | [≤3] |
| Crystal | Pending | [Negative] |
MN, mononuclear cells (including lymphocytes and monocytes); PMN, polymorphonuclear cells (mainly neutrophils).
Discussion
Triangular fibrocartilage complex tears are a common cause of ulnar-sided wrist pain and are frequently associated with decreased wrist functionality and grip strength, often resulting from traumatic injuries, degenerative changes, or overuse of the hand. In many cases, conservative management and debridement are effective for symptom relief, yet tissue regeneration remains limited.
Clinically, the patient’s symptoms were initially attributed to ECU tendinitis, as the presentation resembled a benign soft-tissue condition. However, on imaging, TFCC pathology must routinely be differentiated from other ulnar-sided wrist abnormalities that can show overlapping features on T1- and T2-weighted sequences, such as degenerative TFCC changes, ulnocarpal synovitis, lunotriquetral ligament injury, or findings associated with ulnar impaction syndrome[16]. In this case, the MRI appearance did not support these alternative radiologic differentials, and the findings were more consistent with a TFCC tear. Persistent pain or restricted wrist motion after surgery often motivates the exploration of regenerative adjuncts such as MSCs and their secretome[17–19].
Patient outcomes showed a significant reduction in pain, along with improved function, was observed within the first month following the injection. Patients also experience weakness in grip strength and lifting, as observed in this case. Arthroscopy and wrist casting had been previously performed as initial steps in monitoring the patient’s condition and in the process of obtaining a precise diagnosis. With the patients’ conditions, the patient still required adjuvant treatment. Regenerative therapy was administered through intra-articular injection of UC-MSCs and their secretome. This case report highlights the potential of UC-MSCs and their secretome in treating TFCC tears, showing significant pain reduction and improved function. By 6 months, pain was completely resolved (VAS 0/10), with the DASH score improving from 51 (poor) to 12 (good), indicating meaningful recovery in wrist function. The improvement persisted through the 12-month follow-up, during which the patient maintained a VAS of 0 and further improved functionally (DASH 5.8, excellent). The regenerative properties of UC-MSCs and their secretome are believed to play a crucial role in reducing pain and promoting tissue repair[9,20]. The DASH score decrease provides validity to the clinical observations of enhanced wrist function and reduced impairment. These findings suggest that the treatment not only alleviates pain but also enhances overall functionality, contributing to the patient’s return to normal daily activities. MRI findings confirmed stable TFCC structure with no signs of recurrent tear or degeneration, suggesting durable therapeutic benefit.
These long-term outcomes strengthen the hypothesis that UC-MSCs and their secretome may not only accelerate early recovery but also sustain tissue regeneration and functional stability. The prolonged improvement could be explained by the continued paracrine effects of UC-MSCs and their bioactive secretome components, which support the local microenvironment and maintain anti-inflammatory balance over time. UC-MSCs therapy holds great potential in addressing TFCC tears. UC-MSCs can regenerate cartilage through several mechanisms such as homing, angiogenesis, differentiation, and response to inflammation (Russo et al). Mesenchymal stem cells derived from the umbilical cord have advantages compared to MSCs from adipose tissue or bone marrow. Some of these advantages include higher proliferation rates abundant stem cell supply without risk to the donor, and higher purity levels. UC-MSCs have a different secretome than MSCs from other sources, such as bone marrow and adipose tissue[21].
Mesenchymal stem cells have shown promising and clinically meaningful benefits in orthopedics, particularly in osteoarthritis, where multiple meta-analyses have demonstrated their safety and effectiveness[10–12]. However, research on MSCs specifically for TFCC injuries remains very limited.
UC-MSCs also secrete growth factors that play roles in homing, migration, proliferation, and differentiation. Growth factors involved in the cartilage repair process include bone morphogenetic proteins (BMPs), HGF, PDGF, IGF, epidermal growth factor (EGF), VEGF, and TGF. Furthermore, UC-MSCs can inhibit chondrocyte apoptosis and increase the expression of chondrogenesis-related genes including Col-2 and Sox9[22]. The UC-MSCs secretome is rich in angiogenic factors, chemokines, and anti-inflammatory cytokines, with lower concentrations of metalloproteinases (MMPs). These properties position the UC-MSC secretome as a promising treatment option for musculoskeletal conditions such as TFCC tears[23]. The secretome also plays a role in attenuating the inflammatory conditions that cause wrist pain. Cytokines, as one of the soluble proteins present in the secretome, play a significant role as anti-inflammatory agents[24,25].
The anti-inflammatory effects of UC-MSCs and their secretome occur by modulating key signaling pathways. The secretome inhibits nuclear factor-kappa B (NF-κB), a transcription factor central to the inflammatory response, reducing the production of pro-inflammatory cytokines like IL-1β and IL-6, which contribute to pain and cartilage damage. Additionally, the UC-MSC secretome contains anti-inflammatory cytokines such as IL-10, which help counteract inflammation and support tissue healing[26]. The secretome also contains various bioactive molecules, such as growth factors and anti-inflammatory cytokines, which are essential in regulating pain pathways. For instance, transforming growth factor-beta (TGF-β) and insulin-like growth factor-1 (IGF-1) present in the secretome can promote tissue repair and regeneration while also exerting analgesic effects[27] The presence of extracellular vesicles (EVs) within the secretome further enhances these effects by facilitating communication between cells and promoting anti-inflammatory signaling[28].
The clinical product used in this case, MeSCPro® (UC-MSCs) and USEPro® (UC-MSC-derived secretome), manufactured under GMP conditions by PT. Prodia StemCell Indonesia, were administered through repeated intra-articular injections. This repeated low-dose strategy likely contributed to sustained benefits by maintaining the bioactivity of the regenerative components in the joint environment.
Based on the examination results after 12-month post-injection, the patient showed improvements in grip strength, lifting ability, and reduced joint pain and clicking. This is because gradually administering MSC and secretome through intra-articular injection can maintain their function without loss. Conversely, single injections may pose a higher risk to maintaining MSC function at the target site. If supported by larger studies, UC-MSC and secretome therapy may be considered as an adjunct option for TFCC tears that fail to improve after conventional treatment. Future clinical guidelines may incorporate regenerative biologics as part of a stepwise management algorithm.
Strength and limitations
The strength of this report lies in its relevance and novelty. It is among the earliest documented cases to use UC-MSCs and UC-MSC-derived secretome as an adjuvant therapy for TFCC tears, addressing a clear gap in regenerative evidence for wrist injuries. This report is also supported by multi-assessments, including MRI, VAS, and DASH.
This study has several limitations. The short duration of observation necessitates long-term evaluation to confirm the sustained efficacy of the therapy. Additionally, the small sample size limits the generalizability of the findings, and larger studies are required to improve the accuracy of the result. Further research with a more robust design is needed to strengthen these conclusions.
Conclusion
The administration of multiple injections of UC-MSCs and their secretome in TFCC injury patients primarily resulted in a significant reduction in pain, alongside improvements in grip strength and lifting ability. The use of UC-MSCs and their secretome played a crucial role in reducing inflammation, alleviating pain, and supporting the chondrogenesis process in the TFCC tears.
Acknowledgements
We acknowledge PT Prodia StemCell Indonesia for providing the Mesenchymal Stem Cell product (MeSCPro®) and the secretome product (UsePro®), which have been essential to this study/presentation. This work was previously presented at the 2025 Indonesian Orthopaedic Mechano Biology Society (IOMBS) congress 2025 in Bandung, Indonesia.
Footnotes
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Contributor Information
Jecky Chandra, Email: chandra.jecky@yahoo.com.
Cynthia Retna Sartika, Email: c.sartika@gmail.com.
Rima Haifa, Email: rima.haifa@prostem.co.id.
Nisa Zulfani, Email: nisa.zulfani@prostem.co.id.
Ethical approval
Ethical approval was not required for this case report in accordance with institutional policies. Written informed consent was obtained from the patient.
Consent
The patient provided written informed consent to participate in the study and to allow the publication of this case report and any accompanying clinical images.
Sources of funding
This study was supported by PT Prodia StemCell Indonesia through the provision of UC-MSC and secretome materials. Members of the ProSTEM research team participated as coauthors and contributed to the preparation of the manuscript and the decision to submit it for publication. The sponsor had no role in data collection, data analysis, or data interpretation.
Author contributions
J.C.: Conceptualization, Study design, Data analysis, Manuscript review and critical revision. C.R.S.: Conceptualization, Contribution to study design and scientific input. R.H.: Conceptualization, Contribution to study methodology and scientific input. N.Z.: Conceptualization, Contribution to study methodology and scientific input, Primary manuscript drafting and preparation, Coordination of manuscript development.
Conflicts of interest disclosure
The authors declare no conflict of interest.
Research registration unique identifying number (UIN)
Not applicable.
Guarantor
Rima Haifa is the guarantor of this study.
Provenance and peer review
Not commissioned, externally peer-reviewed.
Data availability statement
De-identified imaging files and supplementary data are available from the corresponding author on reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
De-identified imaging files and supplementary data are available from the corresponding author on reasonable request.