TFCC injuries: How we treat?

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Abstract

Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. 2. Eur Radiol. 2023 Sep;33(9):6322-6338. doi: 10.1007/s00330-023-09698-7. Epub 2023 May 16. Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries. Cerezal L(1), Del Piñal F(2), Atzei A(3)(4), Schmitt R(5)(6), Becce F(7)(8), Klich M(9), Bień M(10), de Jonge MC(11), Teh J(12), Boutin RD(13), Toms AP(14), Omoumi P(15), Fritz J(16), Bazzocchi A(17), Shahabpour M(18), Zanetti M(19), Llopis E(20), Blum A(21), Lalam RK(22), Reto S(23)(24), Afonso PD(25)(26), Mascarenhas VV(25)(27), Cotten A(28)(29), Drapé JL(30), Bierry G(31), Pracoń G(10), Dalili D(32), Mespreuve M(33), Garcia-Elias M(34), Bain GI(35), Mathoulin CL(36), Van Overstraeten L(37)(38), Szabo RM(39), Camus EJ(40)(41), Luchetti R(42), Chojnowski AJ(43), Gruenert JG(44), Czarnecki P(45), Corella F(46)(47)(48), Nagy L(49), Yamamoto M(50), Golubev IO(51), van Schoonhoven J(52), Goehtz F(52), Sudoł-Szopińska I(#)(53), Dietrich TJ(#)(24)(54). Author information: (1)Radiology Department, Diagnóstico Médico Cantabria (DMC), Castilla 6-Bajo, 39002, Santander, Spain. lcerezal@gmail.com. (2)Instituto de Cirugía Plástica Y de La Mano, Serrano 58 1B, 28001, Madrid, Spain. (3)Pro-Mano, Treviso, Italy. (4)Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy. (5)Department of Radiology, University Hospital LMU Munich, Ziemssenstraße 5, 80336, München, Germany. (6)Department of Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany. (7)Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland. (8)University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. (9)Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland. (10)Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland. (11)Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands. (12)Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK. (13)Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA. (14)Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK. (15)Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland. (16)Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA. (17)Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy. (18)Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. (19)Kantonsspital Baden, Im Ergel 1, CH-5404, Baden, Switzerland. (20)Hospital de La Ribera. IMSKE. Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain. (21)Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 Avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France. (22)Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK. (23)Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008 Radiology, Zurich, Switzerland. (24)Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland. (25)Imaging Center, Radiology Department, Musculoskeletal Imaging Unit, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal. (26)Hospital Particular da Madeira, HPA, Madeira, Portugal. (27)AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal. (28)Musculoskeletal Radiology Department, Lille University Hospital Center, 59037, Lille, France. (29)Lille University School of Medicine, Lille, France. (30)Service de Radiologie B, AP-HP Centre, Groupe Hospitalier Cochin, Université de Paris, 75014, Paris, France. (31)MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France. (32)Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, KT18 7EG, London, UK. (33)Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium. (34)Hand and Upper Extremity Surgery, Creu Blanca, Pº Reina Elisenda 57, 08022, Barcelona, Spain. (35)Department of Orthopaedic Surgery, Flinders Medical Centre and Flinders University, Adelaide, South, Australia. (36)International Wrist Center, Clinique Bizet, 23 Rue Georges Bizet, 75116, Paris, France. (37)Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium. (38)Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik 808, Brussels, Belgium. (39)Department of Orthopaedic Surgery, Health System, University of California Davis, 4800 Y Street, Sacramento, CA, 95817, USA. (40)IMPPACT Hand Surgery Unit, Clinique de Lille Sud, 94 Bis Rue Gustave Delory, Lesquin, France. (41)Laboratoire d'anatomie Fonctionnelle, ULB, Bruxelles, Belgium. (42)Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy. (43)Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK. (44)Department of Hand and Plastic Surgery Berit Klinik, Klosterstrasse 19, 9403, Goldach, Switzerland. (45)Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Ul. 28 Czerwca 1956R. Nr 135/147, 61-545, Poznań, Poland. (46)Orthopedic and Trauma Department. Hospital, Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain. (47)Hand Surgery Unit. Hospital Universitario Quirónsalud Madrid, Madrid, Spain. (48)Surgery Department, School of Medicine, Universidad Complutense, Madrid, Spain. (49)Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich, Switzerland. (50)Department of Hand Surgery, Nagoya University, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Japan. (51)Hand and Microsurgery Division, Priorov Central Institute of Traumatology and Orthopedy, Moscow, Russia. (52)Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany. (53)Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland. (54)Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland. (#)Contributed equally Comment in Eur Radiol. 2023 Sep;33(9):6320-6321. doi: 10.1007/s00330-023-09775-x. OBJECTIVES: The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique. METHODS: Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panelists consisted of twenty-seven musculoskeletal radiologists. The panelists scored their degree of agreement to each statement on an 11-item numeric scale. Scores of "0," "5," and "10" reflected complete disagreement, indeterminate agreement, and complete agreement, respectively. Group consensus was defined as a score of "8" or higher for 80% or more of the panelists. RESULTS: Three of fourteen statements achieved group consensus in the first Delphi round and ten statements achieved group consensus in the second Delphi round. The third and final Delphi round was limited to the one question that did not achieve group consensus in the previous rounds. CONCLUSIONS: Delphi-based agreements suggest that CT with static axial slices in neutral rotation, pronation, and supination is the most useful and accurate imaging technique for the work-up of DRUJ instability. MRI is the most valuable technique in the diagnosis of TFCC lesions. The main indication for MR arthrography and CT arthrography are Palmer 1B foveal lesions of the TFCC. CLINICAL RELEVANCE STATEMENT: MRI is the method of choice for assessing TFCC lesions, with higher accuracy for central than peripheral abnormalities. The main indication for MR arthrography is the evaluation of TFCC foveal insertion lesions and peripheral non-Palmer injuries. KEY POINTS: • Conventional radiography should be the initial imaging technique in the assessment of DRUJ instability. CT with static axial slices in neutral rotation, pronation, and supination is the most accurate method for evaluating DRUJ instability. • MRI is the most useful technique in diagnosing soft-tissue injuries causing DRUJ instability, especially TFCC lesions. • The main indications for MR arthrography and CT arthrography are foveal lesions of the TFCC. © 2023. The Author(s), under exclusive licence to European Society of Radiology. DOI: 10.1007/s00330-023-09698-7