Artikel
New Arthroscopic Classification of TFCC injuries
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Autoren
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Toshiyasu Nakamura
- International University of Health and Welfare, School of Medicine, Tokyo, Japan
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Koji Abe
- International University of Health and Welfare, Clinical Research Center, Tokyo, Japan
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Due to several reports of other types of TFCC injury that was not in Palmer's classification, such as the dorsal or coronal tear or due to recent development of DRUJ arthroscopy, we need new thorough classification of TFCC injury both includes RCJ and DRUJ sides. We tried to classify our case series of consecutive 213 TFCC lesions in a year period.
Methods: From July 2014 to September 2015 (1 year 2 months period), 213 wrists of 211 TFCC injury patients who underwent first-look arthroscopy both in the RCJ and DRUJ were included in this study. There were 123 males and 88 females, right wrist of 116; left of 93 and 2 bilateral. Average age of arthroscopy was 39.1 year (range: 13-72). All data were recorded on cards and DVDs.
Results and Conclusions: On radiocarpal arthroscopy, 191 TFCC injuries were categorized as traumatic and 48 as degenerative. The central TFC lesion (Class 1) was noted in 21 wrists: among them, 13 slit tears, 2 flap, 1 double transverse slit, 2 oblique, 1 coronal, and 2 bucket handle tears were found. The radial tear (Class 2) was in 5 wrists including 4 intra-disc tear and 1 rim tear. Peripheral tear (Class 3) was found in 165 including 150 ulnar tears, 10 dorsal, 1 distal, 2 palmar and 2 horizontal tears. 48 wrists indicated degenerative tear (Class 4). On DRUJ arthroscopy, traumatic TFCC injuries were found in 19 wrists, subclassified into proximal slit and proximal fibrillation (Stage 1) in 4, partial RUL avulsion (Stage 2) in 1, relaxed RUL (Stage 3) in 3 and complete RUL avulsion (Stage 4) in 17. Isolated injury was found in 144 wrists (67%), double lesions were found in 65 wrists (30%), and triple injuries were found in 4 wrists.
We classified TFCC lesion based upon RCJ (Class 1-4 as the site of injury) and DRUJ (Stage 1-4 as the degree of RUL tears) arthroscopic findings. This system works very well. One third of our series indicated combined double or triple lesion that included lesions onto the RCJ and DRUJ. To diagnose TFCC lesion thoroughly, both RCJ and DRUJ arthroscopy are necessary.
