Review and update on the management of triangular fibrocartilage complex injuries in professional athletes

Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.

High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists： Correlation with Cross-sectional Anatomy

Background：The injury of the triangular fibrocartilage complex （TFCC） is a common cause of ulnar-sided wrist pain.The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging （MRI） could demonstrate the detailed complex anatomy of TFCC in Chinese.Methods：Fourteen Chinese cadaveric wrists （from four men and three women;age range at death from 30 to 60 years;mean age at 46 years） and forty healthy Chinese wrists （from 20 healthy volunteers,male/female：10/10;age range from 21 to 53 years with a mean age of 32 years） in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study.All cadavers and volunteers had magnetic resonance （MR） examination of the wrist with coronal T 1-weighted and proton density-weighted imaging with fat suppression in three planes,respectively.MR arthrography （MRAr） was performed on one of the cadaveric wrists.Subsequently,all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw （six in coronal plane,four in sagittal plane,and four in axial plane）.The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists.Results：Triangular fibrocartilage,the ulnar collateral ligament,and the meniscal homolog could be best observed on images in coronal plane.The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane.The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane.The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr.Conclusion：High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

The role of radiocarpal injection arthrography and magnetic resonance imaging in the diagnosis of triangular fibrocartilage complex injuries

Objective:: To investigate the radiocarpal joint injection arthrography and magnetic resonance imaging for diagnosis of the triangular fibrocartilage complex (TFCC) injuries. Methods: Thirteen cases whose main complaints were ulnar wrist pain were given radiocarpal joint arthrography and eight of them were also given magnetic resonance imaging for evaluating the integrity of the triangular fibrocartilage complex. Results: Ten of thirteen cases presented the leakage of contrast medium to distal radioulnar joint from the radiocarpal joint, in whom, 8 were demonstrated triangular fibrocartilage tear on magnetic resonance imaging, and 3 located at radial side, 2 at central, 3 at ulnar side. One of three cases which were demonstrated without the leakage of contrast medium in arthrography were displayed with marked TFCC tear on magnetic resonance imaging. Conclusions: The wrist arthrography can provide a definite diagnosis for triangular fibrocartilage disruption with higher sensitivity. magnetic resonance imaging not only demonstrates the site of triangular fibrocartilage disruption as the same value as wrist arthrography, but also displays the other related bony and soft tissues changes.

CONGENITAL PERFORATION OF THE TRIANGULAR FIBROCARTILAGE OF THE WRIST

The triangwlar fibrocartilages(TFC) of 136 wrist joints from 48 fetuses and 20 infants fresh cadavers without any evidence of known deformity and injary were studied .Perforations of the TFC were found not only in infants(18.8%),but also in fetuses(25%).