Update TFCC: histology and pathology, classification, examination and diagnostics

Kirchberger, Michael C.; Unglaub, Frank; Mühldorfer-Fodor, Marion; Pillukat, Thomas; Hahn, Peter; Müller, Lars Peter; Spies, Claudia

doi:10.1007/s00402-015-2153-6

Cited by 79 publications

(40 citation statements)

References 91 publications

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“…Indeed, highly sophisticated MRI techniques facilitate accurate diagnosis. [13][14][15] However, the MRIs that we are faced with in daily practice do not always meet the required quality criteria. Wrist curls and contrast media are not consequently used, and radiologists are not always experienced in medical imaging for wrist pathologies.…”

Section: Discussionmentioning

confidence: 99%

“…Wrist curls and contrast media are not consequently used, and radiologists are not always experienced in medical imaging for wrist pathologies. [15][16][17] Therefore, Hahn et al 16 did not recommend the general use of MRI in the diagnosis of ulnar-sided wrist pain. In this context, and with respect to considerations of cost-effectiveness, it is questionable, whether a diagnosis has to be compelled by MRI before arthroscopy, when a TFCC pathology is suspected on clinical examination.…”

Section: Discussionmentioning

confidence: 99%

“…20 However, the clinical assessment of DRUJ instability, is not trivial as it is influenced by the patients' compliance and by the examiners' experience. 15 All the same, the arthroscopic diagnosis of an isolated foveal detachment is demanding, and misdiagnosis is not uncommon. This is further illustrated by the present study, since 15 of the 133 repeated arthroscopies were performed to reassess the foveal TFCC attachment.…”

Section: Discussionmentioning

confidence: 99%

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Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

et al. 2016

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Frequently, patients undergo repeated wrist arthroscopies for single wrist problems. The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures. For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies. Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists. In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures. Level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

et al. 2016

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“…Injuries and degenerative changes of the triangular fibrocartilage complex (TFCC) are a common cause of ulnar-sided wrist pain and disabilities [1][2][3]. Despite improvement in understanding and classification of these lesions, controversy remains regarding management and evidence-based recommendations for the treatment of TFCC lesions could not be concluded from literature [4].…”

Section: Introductionmentioning

confidence: 99%

Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint

Sander

Sommer

Kaiser

et al. 2020

Eur J Trauma Emerg Surg

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Purpose Triangular fibrocartilage complex (TFCC) lesions have high clinical relevance. Although multiple studies have been done in the past, there is a lack of data after conservative treatment and controversy remains regarding management. The purpose of this study was to compare the outcome of symptomatic TFCC lesions after conservative treatment and arthroscopic debridement. Methods Between 2012 and 2017, 33 patients were included. 16 patients were treated conservatively and 17 patients with arthroscopic debridement. The average age was 41 years (range 18-63). The mean follow-up was 22.2 months (range 6-74). Evaluation included pain, range of motion (ROM), grip strength, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Modified Mayo Wrist Score (MMWS), and Purdue Pegboard test. Results Pain averaged 0.1 (range 0-1) in the conservative group compared to 1.3 (range 0-6) in the arthroscopic group. The mean ROM was 99% for wrist extension, and 100% for flexion and pro-/supination in the conservative group, and 96% for extension and flexion, and 100% for pro-/supination in the arthoscopic group compared to the contralateral side. Grip strength was 88% (range 63-100) in the conservative group versus 89% (range 33-100) in the arthroscopic group. The conservative group reached a DASH score of 16.8 and MMWS of 94.3 compared to 22.1 and 87.2 in the arthroscopic group. The differences were not statistically significant. Conclusions Our study demonstrated similar results of conservative compared to arthroscopic treatment. Because conservative treatment was a sufficient and reliable option, we propose it as first-line treatment for TFCC lesions with stable distal radioulnar joint.

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“…понимание его анатомии и основанной на ней классификации позволяет определить так-тику лечения [15].…”

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Arthroscopic for Treatment of Wrist Pathologies

Golubev

Саутин²,

Балюра

2018

Traumatology and Orthopedics of Russia

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Diagnostics and treatment of wrist joint pathologies still remain one the key problems in hand traumatology and orthopaedics. Extremal sports availability as well as new options for recreation transportation means only sustains the statistics of such injuries. On the other hand, the technological improvements allowed to develop precise optics for surgeries on small joints. Possibilities of minimally invasive closer visualization at magnification substantially changed not only the approach to treatment of wrist joint pathology but also allowed to describe types of lesions unknown earlier. The authors describe basic principles of wrist joint arthroscopy and features of its application in various injuries: scaphoid fractures, intraarticular fractures of distal radius metaepiphysis, triangular fibrocartilage complex injuries.

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Update TFCC: histology and pathology, classification, examination and diagnostics

Cited by 79 publications

References 91 publications

Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

Outcome of conservative treatment for triangular fibrocartilage complex lesions with stable distal radioulnar joint

Arthroscopic for Treatment of Wrist Pathologies

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