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Results for “Triangular Fibrocartilage”

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PubMed1997

MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation.

OBJECTIVE: The goal of this study was to compare MR imaging with arthroscopy in evaluating triangular fibrocartilage (TFC) pathology. MATERIALS AND METHODS: The results of 178 MR imaging examinations of the wrist were independently reviewed by two musculoskeletal radiologists who were unaware of the the clinical history, including any subsequent surgery. One hundred forty-nine of these studies were obtained from symptomatic patients. Of these patients, 56 underwent arthroscopic evaluation of the TFC. The remaining 29 studies were obtained from control volunteers and duplicate cases to reduce bias. The data were divided into categories based on Palmer's classification of TFC injury. Diagnostic sensitivity, specificity, and accuracy were calculated for each category. RESULTS: Of the 56 patients who underwent arthroscopic evaluation of the TFC, 27 had TFCs that were intact at surgery. Also, 27 complete perforations and two partial defects were found at surgery. Sensitivity for detecting central degenerative perforations was 91% for both observers I and II. Sensitivity for detecting radial slitlike tears was 100% and 86% for observers I and II, respectively. Sensitivity for detecting ulnar-sided avulsions was 25% and 50% for observers I and II, respectively. CONCLUSION: MR imaging is accurate in revealing TFC perforations.

Adult↗

PubMed1997

Arthroscopic repairs of triangular fibrocartilage complex tears.

Technical advancements in arthroscopic wrist procedures have improved our knowledge of normal and abnormal intraarticular wrist function. Triangular fibrocartilage complex (TFCC) tears from trauma injuries are a common source of ulnar-sided wrist pain. Fortunately, the TFCC is a structure that can be evaluated and treated arthroscopically with results that are comparable to open surgical procedures. Successful arthroscopic repairs of TFCC tears depend on a coordinated team effort between perioperative nurses, orthopedic surgeons, nurse practitioners, and occupational hand therapists, as well as cooperation from patients and family members. This article reviews the anatomy and physiology of the TFCC, the biomechanics of the wrist and mechanisms of injury, and arthroscopic repairs of TFCC tears.

Arthroscopy↗

PubMed2000

The effect of an exogenous fibrin clot on the regeneration of the triangular fibrocartilage complex: an in vivo experimental study in dogs.

The effect of an exogenous fibrin clot on the regeneration of the triangular fibrocartilage complex (TFCC) was examined in a dog model. In 12 mature dogs, bilateral TFCC resection was performed. The resulting defect was packed with an exogenous fibrin clot (experimental) while the contralateral side was left empty (control). Tissue regeneration was evaluated grossly and histologically at 6, 12, and 26 weeks. At each time period, the regenerated tissue in the fibrin clot-filled defect appeared more mature and more congruent with the adjacent cartilaginous surfaces than did the control (empty) defect. At 26 weeks, the clot regenerated tissue had the histological appearance of a normal TFCC with a homogeneous fibrocartilaginous matrix, regularly oriented collagen fibers, and normal integration with the adjacent support structures of the joint. The results of this study indicate that an exogenous fibrin clot could be used to promote a fibrocartilaginous repair tissue for a resected TFCC. Such therapy could be used in the arthroscopic treatment of TFCC injury and resection in an effort to improve postoperative outcome.

Animals↗

PubMed1992

Age-associated changes of the triangular fibrocartilage of the wrist: evaluation of the diagnostic performance of MR imaging.

To define the appearance of degenerative changes of the triangular fibrocartilage (TFC) of the wrist on magnetic resonance (MR) images, the TFCs in one wrist of each of 30 healthy subjects in three age groups (20-35, 36-50, and greater than 50 years) and six TFCs from fresh cadavers were examined by means of coronal T1-weighted spin-echo sequences. Histologic findings were compared with findings on MR images in the cadaveric TFCs. It was proved that patches or lines of signal hyperintensity within the cadaveric TFCs were caused by degenerative changes and tears. Similar changes of the TFCs on MR images of the healthy subjects may have been caused by degeneration. In the healthy subjects, degenerative changes of the TFC, usually well defined on MR images, occurred at a very early age. The TFC appears to undergo stages of degeneration comparable to those of the menisci of the knee, but differentiation between traumatic and degenerative tears may be difficult.

Adult↗

PubMed1994

Triangular fibrocartilage in asymptomatic subjects: investigation of abnormal MR signal intensity.

PURPOSE: To investigate the prevalence of abnormally high signal intensity of triangular fibrocartilage (TFC) tears on magnetic resonance (MR) images of asymptomatic subjects. MATERIALS AND METHODS: MR images of one wrist in 70 asymptomatic volunteers (age range, 15-78 years) were evaluated for TFC high signal intensity. Findings at MR imaging and topographic parameters of each wrist studied were correlated with the subject's age. Any vertical or horizontal high-intensity slits that reached the joint surface or evidence of a perforation was considered abnormal. RESULTS: Abnormally high TFC signal intensity was seen on images of 35 (50%) wrists. Further, a thin TFC was more often seen in subjects with positive variance, and positive ulnar variance and thin TFC were associated with high signal intensity. Age did not substantially affect the presence or absence of high signal intensity. CONCLUSION: Since TFC high signal intensity was frequently detected in these asymptomatic wrists, MR imaging cannot reliably be used to detect clinically meaningful abnormalities.

Adolescent↗

PubMed1992

[Congenital perforation of the triangular fibrocartilage of the wrist].

The authors dissected 136 wrist joints from fetus and infant fresh cadavers. The perforation rates of the triangular fibrocartilage of the wrist in these two groups were found to be 18.8% and 25%, respectively. The authors believe that, besides traumatic, inflammatory and degenerative causes, some perforations are congenital in origin. They are not found to be correlated with either sex or side of wrists (P > 0.05).

Cartilage Diseases↗

PubMed2004

Arthroscopic surgery for traumatic triangular fibrocartilage complex injury.

Clinical characteristics, diagnostic imaging, arthroscopic findings, and surgical results of arthroscopic treatment are reported in 62 hands with traumatic triangular fibrocartilage complex (TFCC) injury treated between 1995 and 2002. This retrospective study also describes and compares the results of a novel arthroscopic suture technique for repairing tears with Palmer's class 1B and 1D tears. According to Palmer's classification, there were 10 class 1A, 27 1B, 8 1C, and 17 1D injuries. The arthroscopic suture and débridement treatments were done under brachial plexus block as a 1-day in-hospital procedure. Class 1D tears required transradial fixation to anchor the TFCC. Surgical results of suture groups according to Minami's criteria were excellent in 16 hands, good in 15 hands, fair in 1 hand, and poor in 1 hand. The results of the débridement group were excellent in 16 hands, good in 10 hands, fair in 2 hands, and poor in 1 hand. The results of the current study indicate that the novel suture technique were easy to perform, provided strong, tight repair for class 1D injuries, and was applicable for class 1B injuries in this small case series.

Adolescent↗

PubMed2001

Combined arthroscopic TFCC debridement and wafer resection of the distal ulna in wrists with triangular fibrocartilage complex tears and positive ulnar variance.

Because a certain percentage of patients with positive ulnar variance experience incomplete pain relief after triangular fibrocartilage complex (TFCC) debridement alone, we prospectively evaluated the feasibility and efficacy of combining arthroscopic TFCC debridement with arthroscopic wafer resection in such wrists as part of the same surgical procedure. We enrolled 12 patients between July 1998 and July 2000 and performed both subjective and objective assessment at follow-up with a minimum of 6 months and an average of 14 months. Seven posttraumatic and 5 degenerative tears were identified. Preoperative ulnar variance with a pronated grip x-ray averaged 2 mm and ranged between 1 and 4 mm. At final review 8 patients experienced complete pain relief and 4 experienced only minimal symptoms. The ulnocarpal stress test failed to elicit pain in any wrist. Nine patients were very satisfied, and 3 were satisfied. Grip strength improved 8 kg (36%). This procedure should be considered in the treatment of ulnar wrist pain when TFCC tears and positive ulnar variance coexist.

Arthroscopy↗

PubMed2002

Anatomical study of the carpal attachment of the triangular fibrocartilage complex.

There have been few descriptions of the site of attachment onto the triquetrum, the so-called meniscal homologue, of the triangular fibrocartilage complex (TFCC). We have investigated the sites of attachment onto the triquetrum of 87 TFCCs collected from embalmed cadavers. All TFCCs were smoothly attached to the triquetrum. In 79 (46 cases, 90%) they were attached to the triquetrum and fifth metacarpal bone, and in eight (5 cases, 10%) they were attached widely on the articular surface of the triquetrum. It is necessary to have accurate positional information about the normal triquetrum and TFCC in order to perform arthroscopy. The meniscal homologue attached to the triquetrum is smooth in almost all cases. In about 10% of joints the TFCC is attached to the lunotriquetral ligament, either partly or completely obscuring the articular surface of the triquetrum.

Adult↗

PubMedDate not supplied

[Magnetic resonance in the diagnosis of lesions of the carpal triangular fibrocartilage. The experience with 49 patients with chronic pain at the wrist].

In order to evaluate the diagnostic capabilities of MR Imaging in defining triangular fibrocartilage (TFC) lesions, 49 selected patients--21 with rheumatoid arthritis, 13 with traumatic injury and 15 with wrist fracture--presenting chronic wrist pain were examined with MR Imaging. The wrists of 12 healthy subjects were also studied as a control group. MR examinations were performed by means of a superconductive 1.0 T unit (Magnetom-Siemens); SE and GE T1- and T2-weighted pulse sequences were employed to acquire images of the wrists on the coronal, axial and, if necessary, sagittal planes. The results showed peripheral TFC tears in 10 cases, central TFC lesions in 12 cases and TFC lesions with collateral insertion involvement in 9 cases. In 4 patients focal thickening of TFC without disruption was observed. The correct diagnosis was made in all the 19 surgically verified cases. Our experience confirms the clinical value of MR Imaging in the evaluation of TFC lesions in patients with chronic ulnar pain syndrome.

Adolescent↗

PubMed1994

Anatomical and radiological evaluation of the triangular fibrocartilage complex of the wrist.

109 wrists from 69 cadavers (mean age 74 years) have been studied to clarify the pathology and morphology of the triangular fibrocartilage complex (TFCC) and to correlate pathological and radiological findings. Perforation of the TFCC was observed in 65% of the specimens and was considered to be secondary to a degenerative process, because it was often accompanied by degenerative changes in the ulnar carpal bones and perforation of the lunotriquetral ligament. To detect TFCC perforations on plain postero-anterior radiographs, it is important to evaluate ulnar plus variance and degenerative changes in the ulnar carpus. Existence of ulnar plus variance alone is more sensitive but less specific in detection of TFCC perforation than the existence of degenerative changes in the ulnar carpus.

Aged↗

PubMed1990

Triangular fibrocartilage disorders: injury patterns and treatment.

On the basis of their arthroscopic experience with the diagnosis and management of acute and chronic lesions of the triangular fibrocartilage complex (TFCC), the authors review the anatomy and biomechanics of the TFCC, classify TFCC injury patterns, and suggest a treatment program for each pattern of injury. Traumatic patterns included central perforations (Class 1A), ulnar avulsions (Class 1B), distal avulsions (Class 1C), and radial avulsions (Class 1D). Degenerative (ulnar carpal abutment) patterns were classified (Class 2A-2E) by degree of severity and progressive involvement of adjacent structures. Arthroscopic debridement of the horizontal portion of the TFCC for Class 1A lesions and the Wafer procedure for Class 2C lesions have proved to be particularly successful over a 2-year follow-up, but the authors advise close long-term follow-up.

Arthroscopy↗

PubMedDate not supplied

Results of acute arthroscopically repaired triangular fibrocartilage complex injuries associated with intra-articular distal radius fractures.

PURPOSE: This study reviews the results of acute repair of peripheral ulnar-sided triangular fibrocartilage complex (TFCC) detachment associated with intra-articular distal radius fractures. TYPE OF STUDY: Two-year follow-up of patients who had undergone acute TFCC repair. METHODS: Fifty-six patients underwent arthroscopically assisted treatment of intra-articular distal radius fractures using external fixation and adjunctive percutaneous pinning between 1994 and 1998. Thirteen patients with an acute, complete tear of the ulnar attachment of the TFCC were treated using arthroscopic repair of the TFCC in addition to stabilization of the radius fracture. All patients were evaluated at a mean of 24 months (range, 17 to 35 months) with a physical examination, wrist radiographs, and a Disability of Arm, Shoulder, and Hand (DASH) module outcome assessment questionnaire. RESULTS: Average wrist flexion, extension, pronation, and supination were 67.3, 61.8, 79.1, and 86.8, respectively. The average grip strength was 78% of the uninjured side. The results of the Gartland and Werley grading system were good to excellent in 12 patients and fair in 1 patient. The DASH outcome scores revealed a mean functional score of 13 and a mean athletic score of 12. None of the patients reported ulnar-sided pain at follow-up. CONCLUSIONS: Arthroscopically assisted TFCC repair in conjunction with distal radius fixation resulted in a high degree of patient satisfaction and good to excellent clinical outcomes.

Adolescent↗

PubMed2000

Peripheral tears of the triangular fibrocartilage complex cause distal radioulnar joint instability after distal radial fractures.

The aim of this prospective study was to determine whether peripheral tears of the triangular fibrocartilage complex (TFCC) in patients younger than the osteoporotic age (males,<60 years; females, <50 years) were related to chronic distal radioulnar joint (DRUJ) instability. Fifty-one patients (27 women) with displaced distal radial fractures were included in the study. The median age was 41 years (range, 20-57 years). Arthroscopy at the time of fracture showed complete or partial TFCC tears in 43 patients (24 had only peripheral tears, 10 had only central perforations, and 9 had combined tears). The 1-year (range, 11-27 months) follow-up period included an interview, physical examination, and radiographic evaluation. Ten of the 11 patients with complete peripheral TFCC tears had DRUJ instability at the follow-up examination compared with 7 of the 32 patients with only partial or no peripheral tears. Patients with instability of the DRUJ had a worse Gartland and Werley wrist score. Instability was not associated with any radiographic finding either at the time of fracture or at the follow-up examination. Initial fracture or nonunion of the styloid was even slightly more common in stable patients.

Adult↗

PubMed1997

Central perforation of the articular disc of the triangular fibrocartilage complex in a 17-year-old girl: could it be congenital?

A case of a central perforation of the horizontal portion of the triangular fibrocartilage complex in a 17-year-old girl is reported. The age of the patient, along with normal articular surfaces of the ulnar head and ulnar carpus and the lack of an ulnar-positive wrist, made the existence of a degenerative tear unlikely. The possibility that the central perforation in this patient could be congenital suggests that this defect should be considered in the differential diagnosis of ulnar-sided wrist pain in the young patient.

Adolescent↗

PubMed1999

Results of repair of peripheral tears in the triangular fibrocartilage complex using an arthroscopic suture technique.

We present the results of an arthroscopic suture technique for repairing peripheral tears (Palmer type 1 b) of the triangular fibrocartilage complex (TFCC). The 20 patients included in this study were 15-59 years of age; the most common mechanism of injury was a fall on a hyperextended wrist. After diagnosis of the tear in the TFCC we debrided the synovitis and repaired the tears by an arthroscopic suture technique. At follow up 23-59 months postoperatively, range of movement (sum of flexion-extension) was 90% (range 53%-108%) and grip strength was 83% (range 18%-122%) when compared with the uninjured side. All patients returned to work, though three changed occupations. The arthroscopic suture technique of peripheral TFCC repair produced seven excellent, seven good, four fair, and two poor results (grading based on a Mayo modification of the Green and O'Brien wrist score). As our results are comparable to others, we think that the technique described could be used in the repair of peripheral tears of the TFCC.

Accidental Falls↗

PubMedDate not supplied

MR evaluation of triangular fibrocartilage complex tears in the wrist: comparison with arthrography and arthroscopy.

To evaluate the accuracy of magnetic resonance (MR) in the detection of tears of the triangular fibrocartilage complex (TFCC), 10 consecutive patients with posttraumatic chronic wrist pain were examined with MR, arthrography, and arthroscopy and the results were compared. The MR images of 16 control subjects were also examined to define the MR appearance of the normal TFCC. When compared with arthroscopic findings, both MR and arthrography had two false-negative results (sensitivity, 80%) and no false-positive results. Regarding the sites of the TFCC tears, the findings on MR did not always correlate with the findings on arthrography. In no case was MR able to visualize the cartilaginous lesions visible by arthroscopy. These preliminary results illustrate the ability of MR to assess the integrity of the TFCC and suggest its use as the first imaging technique following plain radiography in the evaluation of patients with chronic posttraumatic pain on the ulnar side of the wrist.

Adult↗

PubMed2001

Peripheral tears of triangular fibrocartilage complex: results of primary repair.

In 16 patients with ulnar wrist pain, we performed primary arthroscopic or open repair of the peripheral rim tears of the triangular fibrocartilage complex (TFCC) (14 ulnar, 4 volar, and 3 radial tears). The wrist function was assessed before and 1 year after the repair using the Mayo-modified wrist score. The average pain score improved from 9.1+/-8.0 to 21.2+/-6.5, the average functional score from 5.0+/-8.1 to 20.6+/-6.3, the average motion score from 4.7+/-2.8 to 15.6+/-7.3, and the average grip point from 4.4+/-3.5 to 15.6+/-7.7, all with significant differences (P<0.01). Ten of the 17 cases had instability of the distal radioulnar joint and five had recurrent instability after repair.

Adult↗