Classifications of Triangular Fibrocartilage Complex Lesions

Since the application of wrist arthroscopy began in 1979,[1] it is now a popular diagnostic tool as well as a treatment tool for wrist disorders, especially for triangular fibrocartilage complex (TFCC) lesions. As distal radioulnar joint (DRUJ) arthroscopy can reveal the proximal lesions of the TFCC, that is, radioulnar ligament (RUL) avulsion at the fovea of the ulna,[2] wrist arthroscopy is now considered gold standard for diagnosis and treatment for TFCC injuries. Since 1989, Palmer's classification has been widely used.[3] Because Palmer's classification was based on findings of radiocarpal joint (RCJ) arthroscopy, this classification does not include proximal lesions of the TFCC or RUL. There are also variations of peripheral TFCC lesions which cannot be classified into Palmer's classification, such as the dorsal or palmer peripheral injury. Correction to Palmer's classification has been tried, such as Atzei's subclassification of Palmer's 1B lesions into five classes with DRUJ arthroscopic findings.[4] Nakamura classified TFCC lesions into four classes (RCJ) and four stages (DRUJ) with RCJ and DRUJ arthroscopic findings.[5]

Nakamura revealed the 3-D structure of the TFCC with functional anatomical, histological, and biomechanics studies.[6] [7] [8] The TFCC is an obvious 3-D structure in the ulnar side of the wrist. All arthroscopic classifications in history based on the surface lesions through arthroscopy, however, did not take care of 3-D functional ideas.

This issue includes the “Special review” of “A new Arthroscopic Classification of TFCC Disorders” described by Drs. Herzberg, Burnier, Nakamura, Pinal and Atzei. This classification includes a 3-D illustration of TFCC lesions, subclassified into D (disc), W (wall), and R (rein) lesions. The authors conclude that this classification is simple, easy to classify the lesions, and with 3-D idea.

Interesting wrist papers, such as the DRUJ arthroplasty, scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist, scaphoid nonunion, all inside TFCC repairs and reconstruction, validation of hook test, procedures of TFCC reconstruction and open scaphotrapeziotrapezoid recontraction, surveys of arthroscopic management of distal radius fractures, and interesting case reports are included in this issue. Don't miss it.

Publication History

Article published online:
22 January 2024

• References

• 1 Chen YC. Arthroscopy of the wrist and finger joints. Orthop Clin North Am 1979; 10 (03) 723-733
• 2 Nakamura T, Matsumura N, Iwamoto T, Sato K, Toyama Y. Arthroscopy of the distal radioulnar joint. Handchir Mikrochir Plast Chir 2014; 46 (05) 295-299
• 3 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (04) 594-606
• 4 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (05) 582-591
• 5 Nakamura T, Takagi T. Differentiated approaches to treat lesions of the TFCC based on new arthroscopic classification. Handchir Mikrochir Plast Chir 2022; 54 (05) 389-398
• 6 Nakamura T, Yabe Y, Horiuchi Y. Functional anatomy of the triangular fibrocartilage complex. J Hand Surg [Br] 1996; 21 (05) 581-586
• 7 Nakamura T, Yabe Y. Histological anatomy of the triangular fibrocartilage complex of the human wrist. Ann Anat 2000; 182 (06) 567-572
• 8 Nakamura T, Makita A. The proximal ligamentous component of the triangular fibrocartilage complex. J Hand Surg [Br] 2000; 25 (05) 479-486