Distal radioulnar joint (DRUJ) instability is a rare but disabling problem. Surgical treatment remains a challenge. The advent of arthroscopic techniques has helped to rebuild the triangular fibrocartilaginous complex (TFCC), especially its deep part. However, isolated TFCC damage is not responsible for instability. Its repair is sometimes not sufficient to restore DRUJ stability, or the chronicity of the injury prevents its direct repair. Open surgical procedures still have a role in these cases. They require a detailed knowledge of the various stabilizers of the DRUJ. Passive and active stabilizers other than the TFCC include the bones, joint capsule, oblique distal bundle of the interosseous membrane and the extensor carpi ulnaris. The objective of this review was to analyze current anatomical and biomechanical data on DRUJ stability. Different arthroscopic and open repair techniques for these structures will be reviewed. Lastly, a decision tree will be presented that can be used to better plan the management of this complex entity, because most of these injuries often occur in combination in RUD instability cases.