American Association for Hand Surgery
Theme: Beyond Innovation

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Changes in the morphology of the triangular fibrocartilage complex (TFCC) on magnetic resonance arthrography related to disruption of ulnar foveal attachment
Jong Woong Park, Professor, MD, PhD1; Ji Hun PARK, MD2; Young Woo Kwon, MD3; In Cheul Choi, MD, PhD3
1Korea University, Seoul, Korea, Republic of (South), 2Korea University Guro Hospital, SEOUL, Korea, Republic of (South), 3Korea University Anam Hospital, SEOUL, Korea, Republic of (South)

Background: Although the triangular fibrocartilage (TFC) with its ulnar foveal attachment is the primary restraint of the distal radioulnar joint (DRUJ), morphologic changes of TFC after foveal tear remains unclear. The aim of this study was to assess whether distally protruding morphology of TFC on MR image, which look like a mountain-top, were associated with presence of foveal tear on arthroscopy.
Methods: One-hundred and thirty-two patients (134 wrists) who underwent MR imaging study and wrist arthroscopy performed by a single surgeon between September 2014 and March 2018 were retrospectively evaluated. The protruding shape of TFC was measured on coronal MR image, by calculating height-to-width (H/W) ratio of TFC (height, perpendicular distance between fovea and distal margin of TFC; width, perpendicular distance between radius attach point to ulnar styloid process). Subject's demographic information, ulnar variance and presence of ulnar styloid nonunion were assessed. The association of the variables and presence of foveal tear was investigated.
Results: Arthroscopy showed TFC foveal tear in 102 wrists and other 32 wrists showed non-foveal tear. Univariable analysis showed H/W ratio and presence of styloid nonunion were significantly greater in the foveal tear group (p < 0.05 for all). Multivariable analysis showed that only H/W ratio of TFC has a positive association with foveal tear (odds ratio [OR], 1.152; 95% CI, 1.0531.261; p = 0.002). Estimated cutoff values for the H/W ratio were 41% (area under the curve [AUC] 0.74).
Conclusions: The protruding shape of TFC represented with height-to-width ratio was associated with foveal tear. It can be used for additional predictor of tears of the foveal attachment of the TFC.


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