Abstract
ObjectiveThe objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents.Materials and methodsProspectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI).ResultsThe cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components.ConclusionMRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.
Highlights
The triangular fibrocartilage complex (TFCC) is a complex of fibro-cartilaginous and ligamentous structures, located between the distal ulna and carpal bones, facilitating distal radioulnar joint (DRUJ) stabilization, carpal stabilization, and axial load transmission [1]
TFCC injury can be sustained by trauma typically due to a fall on the outstretched hand, which is common in adults and children, yet it can result from degeneration due to repetitive forces on the wrist in young athletes and adults [2, 3]
We found no statistical difference in wrist position (p = 0.26) or ulnar variance (p = 0.17) for wrists where a thinner and more stretched TFC configuration was observed
Summary
The triangular fibrocartilage complex (TFCC) is a complex of fibro-cartilaginous and ligamentous structures, located between the distal ulna and carpal bones, facilitating distal radioulnar joint (DRUJ) stabilization, carpal stabilization, and axial load transmission [1]. TFCC injury can be sustained by trauma typically due to a fall on the outstretched hand, which is common in adults and children, yet it can result from degeneration due to repetitive forces on the wrist in young athletes and adults [2, 3]. It is generally considered a Skeletal Radiol (2021) 50:2195–2204 common cause of ulnar-sided wrist pain [3, 4]. Arthroscopy, the diagnostic reference standard, is performed only when prompted by physical examination combined with MRI abnormalities [7]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
