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PubMed1994

The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability.

This study investigated the relative roles of the interosseous membrane (IOM) and triangular fibrocartilage complex (TFCC) in the transmission of force from the hand to the humerus. Our findings suggest a spectrum of forearm destabilizing injuries. The intact radius abutting the capitellum provides the primary restraint to proximal migration of the radius. After radial head excision, up to 7 mm of proximal radial migration can occur under axial compression. If the TFCC or the IOM alone is disrupted, little alteration in load or displacement is evident. When both the midportion of the IOM and TFCC are incompetent, however, further proximal radial migration occurs, the radial stump abuts the humerus, and load is shifted back to the radial column. These data suggest that the central portion of the IOM is the crucial structural subdivision within the IOM acting as a restraint to proximal radial migration. The TFCC also resists proximal radial migration and participates in load transfer. We propose that clinical migration of the radius under an axial load greater than 7 mm implies disruption of both the midportion of the IOM and TFCC.

Adult↗
PubMed1991

Distal ulnar head shortening for treatment of triangular fibrocartilage complex tears with ulna positive variance.

Patients with a tear of the horizontal part of the triangular fibrocartilage complex and ulna plus variance were treated by excision of the distal part of the ulnar head. Three of the seven consecutive patients also had lunotriquetral ligament injuries and had fusions of that joint. Six of the seven patients had either complete relief or marked improvement of symptoms at the distal radioulnar joint. When ulnar shortening is indicated, ulnar head shortening should be considered.

Adult↗
PubMedDate not supplied

Wrist arthroscopy for the treatment of ligament and triangular fibrocartilage complex injuries.

The use of arthroscopy was evaluated in 47 patients who were treated for suspected triangular fibrocartilage complex (TFCC) tears, scapholunate (SL) tears, and/or lunotriquetral (LT) tears. Wrist arthroscopy was performed using traction and standard portals. Any TFCC tear found was debrided to a stable rim. SL and LT tears were debrided to bleeding bone. The range of follow-up was 1.5 to 50 months (average, 15.4 months). Patient grading was determined usin the Mayo Modified Wrist Score. For the 28 patients with TFCC tears, the results were excellent in 13, good in 8, fair in 2, and poor in 5. For the 23 patients with SL tears, the results were 11, 9, 1, and 2, respectively. Of the 5 patients with LT tears, 1 result was excellent, and 4 were poor. Workers compensation did not affect results. Arthroscopic debridement of SL and TFCC tears has proven effective. Debridement of LT tears has not been as successful. Based on our results, we feel that arthroscopic debridement of SL and TFCC tears is warranted.

Arthroscopy↗
PubMed2003

Biomechanical comparison of transosseous and capsular repair of peripheral triangular fibrocartilage tears.

PURPOSE: The purpose of this study was to biomechanically compare the repair strength of peripheral triangular fibrocartilage complex (TFCC) repairs to the distal ulna using transosseous sutures (group I) versus TFCC repairs to the extensor carpi ulnaris tendon subsheath and surrounding dorsal capsule (group II). TYPE OF STUDY: Cadaveric biomechanical study. METHODS: Six matched pairs of fresh-frozen cadaveric upper extremities were procured. Each underwent the creation and repair of a peripheral, ulnar-sided detachment of the TFCC. Following stabilization of the humerus and radius, the maximum translations of the ulna in the dorsal and palmar directions were measured in response to an 8-lb traction load before disrupting the TFCC, after disrupting the TFCC, and after repairing the TFCC. RESULTS: There was a significant increase in the total translation of the ulna following disruption of the TFCC (P <.001) in both groups. The mean and standard deviation of the percent total translation eliminated following TFCC repair for group I specimens (transosseous suture) were 33.8% and 11.6%, respectively. The mean and standard deviation of the percent total translation eliminated following TFCC repair for group II specimens (capsular implantation) were 59.3% and 29.7%, respectively. The observed difference between the repair groups is not significant (P =.157). CONCLUSIONS: While disruption of the TFCC does significantly increase distal radioulnar joint (DRUJ) instability and repair of the TFCC does significantly restore DRUJ stability, the results of this study do not show a significant biomechanical difference between the 2 TFCC repair techniques in a cadaveric model.

Aged↗
PubMed2006

MR imaging of ligaments and triangular fibrocartilage complex of the wrist.

Imaging of the wrist with MR imaging can be difficult because of the small size of this joint, its complex anatomy, and its sometimes poorly understood pathologic lesions. A recent study by Hobby and coworkers of 98 patients revealed that MR imaging of the wrist influences clinicians' diagnoses and management plans in most patients. This article summarizes the current diagnostic criteria that can be useful in interpreting abnormalities of the wrist ligaments and triangular fibrocartilage complex (TFCC) of the wrist in this difficult topic in joint MR imaging.

Humans↗
PubMed1999

Wrist pain with triangular fibrocartilage thickening.

We review the case of a patient who had wrist pain with synovial proliferation due to triangular fibrocartilage (TFC) thickening, whose pain was relieved by total TFC resection. This suggested that TFC thickening should be considered in the evaluation of patients with wrist pain.

Adult↗
PubMed1999

Fat suppression magnetic resonance imaging of the triangular fibrocartilage complex. Comparison with spin echo, gradient echo pulse sequences and histology.

Magnetic resonance imaging (MRI) of the triangular fibrocartilage complex (TFCC) of the wrist was performed in ten healthy volunteers using spin echo T1-weighted (SE-T1), fast spin echo T2-weighted (FSE-T2), gradient echo T2-weighted (GRE-T2) and fat suppression spin echo T1-weighted (FS-T1) images. The images were obtained in the coronal plane and were compared to the corresponding histological coronal sections obtained from five fresh frozen cadavers. In our analysis, the FS-T1 pulse sequence visualized the details of the TFCC best, followed by the GRE-T2 images. Delineation of the TFCC on the SE-T1 and the FSE-T2 was poor. The coronal morphology of the TFCC represented on the fat suppression image was almost identical to the corresponding histological sections. We conclude that the fat suppression MRI clearly shows the complex structure of the TFCC and is useful for the morphological evaluation of the TFCC.

Adult↗
PubMed1995

Treatment of acute injuries of the triangular fibrocartilage complex associated with distal radioulnar joint instability.

One hundred thirty patients who had an injury of the triangular fibrocartilage complex (TFCC) with distal radioulnar joint (DRU) instability were treated operatively. The TFCC injury with DRUJ instability occurred as an isolated lesion in 20. After appropriate fracture stabilization, 86 patients were treated with closed reduction of the DRUJ and radioulnar transfixation with one to two Kirschner wires with the forearm in neutral rotation. In 19 patients the avulsed ulnar styloid was internally fixed, and the DRUJ supplemented with radioulnar transfixation. In 13 patients the ulnar styloid was internally fixed. In 12 patients with radial avulsion fractures the displaced bony fragment was percutaneously fixed with a Kirschner-wire. Postoperatively all the patients were immobilized in a long arm cast in neutral rotation for 6 weeks. The results were excellent in 95%, fair in 30, and poor in 5.

Accidental Falls↗
PubMed1996

Clinical results of treatment of triangular fibrocartilage complex tears by arthroscopic debridement.

In order to determine indications for arthroscopic debridement and the management of triangular fibrocartilage complex (TFCC) tears, we reviewed 16 wrists retrospectively. The mean patient age was 30 years, with a range of 20 to 53 years. The follow-up period averaged 35 months. Two groups were identified: post-traumatic tears (n = 11) and degenerative tears (n = 5). The results of arthroscopic debridement were compared and analyzed based on the preoperative and postoperative evaluation of pain, range of motion, grip strength, return to work, patient acceptance, and complications. Failures were further evaluated to determine identifiable lesions or anatomic defects associated with poor results. Patients with positive ulnar variance and lunotriquentral interosseous ligament tears had a poor clinical outcome. Good results correlated with grip strength; all patients with post-traumatic TFCC tears had excellent results, while those with degenerative TFCC tears did poorly.

Adult↗
PubMed1997

Operative technique for inside-out repair of the triangular fibrocartilage complex.

A technique for arthroscopic inside-out repair of peripheral traumatic (type 1B) tears of the triangular fibrocartilage complex is reported. The technique can be performed using zone-specific cannulas that are commonly used for repairing meniscal tears in the knee. Anatomic dissections were used to show the safe regions around the TFCC where tears are amenable to this type of repair.

Arthroscopes↗
PubMed2002

A method for all-inside arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears.

There have been different descriptions of arthroscopic repair of the Palmer 1B tear of the triangular fibrocartilage complex (TFCC). Both outside-in and inside-out techniques are in common use, but both have the disadvantage of an extra incision to tie the knots and they are time consuming. We present a technique for all-inside repair of Palmer 1B TFCC tears using a technique known from meniscal repair in the knee joint.

Arthroscopy↗
PubMed2006

Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint.

PURPOSE: Laboratory studies evaluating the importance of the stabilizing structures of the distal radioulnar joint (DRUJ) largely have been limited to static design. Clinically, dynamic loading seems to be an important component of DRUJ instability. This study was designed to evaluate the influence of dynamic loading on the stability of the DRUJ with foveal versus styloid triangular fibrocartilage complex (TFCC) disruptions in a laboratory setting. METHODS: Twelve fresh-frozen cadaveric upper-extremity specimens were tested using a dynamic simulator to study the contributions of the 2 ulnar insertions of the TFCC to the dynamic stability of the DRUJ. The specimens were tested in 3 loading conditions (no load, agonist loading, antagonist loading) in 3 different states of the TFCC (intact, foveal disruption, styloid disruption). RESULTS: Without load no significant differences were found for the different conditions of the TFCC. Under loaded conditions the foveal insertion had a greater effect on stability than did the styloid insertion. Under agonist loading significant differences were found during supinating and pronating motions. With antagonist loading a significant difference was found only during supination. CONCLUSIONS: The study results support the clinical impression that dynamic loading is an important component of DRUJ instability and that disruption of the foveal TFCC insertion into the foveal region of the distal ulna can produce instability.

Aged↗
PubMed1999

Dynamic changes in the shape of the triangular fibrocartilage complex during rotation demonstrated with high resolution magnetic resonance imaging.

We studied in vivo dynamic changes in the triangular fibrocartilage complex (TFCC) in ten healthy volunteers using high-resolution magnetic resonance imaging (MRI). A custom made surface coil, which was specially designed to allow movements of the wrist in all directions, was used in this study. MR images in the axial and coronal planes were acquired at maximum pronation, in the neutral position and at maximum supination. During pronation and supination, little deformity of the disc proper was seen on axial sections. In contrast, the ulnar side of the TFCC around the ulnar styloid process showed obvious dynamic changes. The ulnar head translated palmarly to the radius in supination and dorsally in pronation, while there was little change in the position of the fovea of the ulna in relation to the radius. Considering the three-dimensional structure of the TFCC, these findings suggest that the disc proper is strong enough to support the ulnar carpus with little deformity during rotation and that the triangular ligament twists at its origin. During rotation there is friction between the proximal side of the disc proper and the ulnar head. On coronal sections, the disc proper became thinner in pronation due to increased ulnar variance.

Adult↗
PubMed1996

Closed rupture of the flexor digitorum profundus tendon of the little finger caused by calcification of the triangular-fibrocartilage.

A case of rupture of flexor digitorum profundus tendon of the little finger caused by calcification of the triangular fibrocartilage (TFC) is reported. At operation, a round defect of the TFC and rupture of the flexor digitorum profundus tendon (FDP) of the little finger were observed. The defect of TFC was repaired using the palmaris tendon and FDP of the little finger was woven into FDP of the ring finger. Eleven months after operation, the patient had almost full flexion and extension of the distal and proximal interphalangeal joints.

Aged↗
PubMed2005

Magnetic resonance imaging for diagnosing lesions of the triangular fibrocartilage complex.

In a retrospective survey we compared the magnetic resonance imaging (MRI) protocols with the arthroscopic findings for triangular fibrocartilage complex (TFCC) lesions. We found a sensitivity of 0.61 and specificity of 0.88 for MRI. The positive predictive value was 0.85 and the negative predictive value was only 0.68. These values are very similar to those in other recent surveys. These findings and the reviewed publications all indicate that MRI cannot replace arthroscopy. Special coils and MRI-arthrography can significantly enhance the specificity and the sensitivity. A negative MRI is not an endpoint and not a contraindication for further exploration, in particular for arthroscopy.

Arthrography↗
PubMed2003

High-resolution MR imaging of triangular fibrocartilage complex (TFCC): comparison of microscopy coils and a conventional small surface coil.

OBJECTIVE: To compare MR images of the triangular fibrocartilage complex (TFCC) using microscopy coils with those using a conventional surface coil qualitatively and quantitatively. DESIGN AND PATIENTS: Proton density-weighted images and T2*-weighted images of the TFCC from ten normal volunteers were obtained with a conventional surface coil (C4 coil; 80 mm in diameter), a 47-mm microscopy surface coil and a 23-mm microscopy surface coil) at 1.5 T. Qualitative image analysis of MR images with three coils was performed by two radiologists who assigned one of five numerical scores (0, nonvisualization; 1, poor; 2, average; 3, good; 4, excellent) for five TFCC components, which were disc proper, triangular ligament, meniscus homologue, ulnotriquetral and ulnolunate ligament. Quantitative analysis included the signal-to-noise ratio (S/N) of the disc proper of TFCC, the lunate cartilage, the lunate bone and the contrast-noise-ratio (C/N) between articular cartilage and disc proper or bone marrow were measured. RESULTS: All structures show higher scores qualitatively on MR with microscopy coils than those with a C4 coil, and the difference was significant with the exception of the ulnolunate ligament. MR with microscopy coils showed significantly higher S/N values than those with a conventional surface coil (P<0.05 to P<0.001). T2*-weighted images using microscopy coils showed significantly higher cartilage-disc proper C/N and cartilage-bone marrow C/N (P<0.01 to P<0.001). On proton density-weighted images, the C/N between cartilage and disc proper with two microscopy coils was significantly higher (P<0.01) than that with a conventional coil. CONCLUSION: High-resolution MR images of the normal wrist using microscopy coils were superior to those using a conventional surface coil qualitatively and quantitatively. High-resolution MR imaging with a microscopy coil would be a promising method to diagnose TFCC lesions.

Adult↗