The Triangular fibrocartilage complex (TFCC) : New Arthroscopic anatomical description and new arthroscopic classification of its disorders.
Guillaume HERZBERG | MB Marion BURNIER
Seance of wednesday 22 january 2025 (Chirurgie du poignet)
DOI number : 10.26299/h9c6-k703/emem.2025.03.04
Abstract
The « triangular fibrocartilage complex (TFCC)» is a wrist ligamentous complex which stabilizes the distal radius and ulna together. AK Palmer in the eighties and T Nakamura in the nineties provided comprehensive anatomical descriptions of the TFCC including a fibrocartilaginous disc which acts as a shock absorber between the forearm and carpus.
The TFCC integrity is particularly at risk during falls on the hand and forceful torsional trauma of the forearm. There is a spectrum of potential injuries ranging from major DRUJ instability to isolated ulnar wrist pain, all of them being incapacitating in young active patients involved in sports.
Palmer in 1989 provided the first comprehensive 3D classification of TFCC disorders based on a posterior view of the TFCC. Since then, a number of TFCC injuries sub-types have been described. However, neither a 3D arthroscopic anatomy description of the TFCC nor a comprehensive updated classification of its disorders have been provided.
We propose a new arthroscopic 3D anatomical description of the TFCC as observed from a 3-4 portal based on more than 100 wrist TFCC arthroscopies on fresh anatomic specimens and more than 1000 wrist arthroscopies in clinical practice over a 20 year period,. The disc « D », reins « R » and wall « W » are described.
We propose a new arthroscopic comprehensive classification of TFCC disorders as observed from the 3-4 portal (TFCC lesions type « D », « R », « and « W ») based on 109 wrist arthroscopies performed for TFCC management between 2012 and 2024 and a comprehensive review of the literature.
The « D » TFCC lesions are either « DD, disc degenerative » or « DT , disc traumatic ». Their treatment requires debridement and/or decompression since the disc is avascular. The ulnar variance is placed in the center of the classification since we have confirmed that there is a strong correlation between « DD » TFCC injuries and a positive ulnar variance.
The « R » TFCC lesions are traumatic, either foveal avulsion or radial reins avulsions. They usually provide DRUJ instability. Their identification may occasionally require a complementary DRUJ arthroscopy. They require an arthroscopic repair which will be successful since the reins are well vascularized.
The various posterior and anterior « W » TFCC lesions are traumatic. They require an arthroscopic repair which will be successful since the reins are well vascularized.
The combined TFCC lesions are not unusual and may now be clearly identified.
In summary, we present a new comprehensive 3D arthroscopic classification of TFCC disorders as seen from a 3-4 portal based on a new arthroscopic anatomical 3D description of the TFCC. This new comprehensive classification should clarify the TFCC injuries described in clinical series as well as the incidence of combined degenerative and traumatic disorders.
The TFCC integrity is particularly at risk during falls on the hand and forceful torsional trauma of the forearm. There is a spectrum of potential injuries ranging from major DRUJ instability to isolated ulnar wrist pain, all of them being incapacitating in young active patients involved in sports.
Palmer in 1989 provided the first comprehensive 3D classification of TFCC disorders based on a posterior view of the TFCC. Since then, a number of TFCC injuries sub-types have been described. However, neither a 3D arthroscopic anatomy description of the TFCC nor a comprehensive updated classification of its disorders have been provided.
We propose a new arthroscopic 3D anatomical description of the TFCC as observed from a 3-4 portal based on more than 100 wrist TFCC arthroscopies on fresh anatomic specimens and more than 1000 wrist arthroscopies in clinical practice over a 20 year period,. The disc « D », reins « R » and wall « W » are described.
We propose a new arthroscopic comprehensive classification of TFCC disorders as observed from the 3-4 portal (TFCC lesions type « D », « R », « and « W ») based on 109 wrist arthroscopies performed for TFCC management between 2012 and 2024 and a comprehensive review of the literature.
The « D » TFCC lesions are either « DD, disc degenerative » or « DT , disc traumatic ». Their treatment requires debridement and/or decompression since the disc is avascular. The ulnar variance is placed in the center of the classification since we have confirmed that there is a strong correlation between « DD » TFCC injuries and a positive ulnar variance.
The « R » TFCC lesions are traumatic, either foveal avulsion or radial reins avulsions. They usually provide DRUJ instability. Their identification may occasionally require a complementary DRUJ arthroscopy. They require an arthroscopic repair which will be successful since the reins are well vascularized.
The various posterior and anterior « W » TFCC lesions are traumatic. They require an arthroscopic repair which will be successful since the reins are well vascularized.
The combined TFCC lesions are not unusual and may now be clearly identified.
In summary, we present a new comprehensive 3D arthroscopic classification of TFCC disorders as seen from a 3-4 portal based on a new arthroscopic anatomical 3D description of the TFCC. This new comprehensive classification should clarify the TFCC injuries described in clinical series as well as the incidence of combined degenerative and traumatic disorders.