Chấn thương TFCC Thông tin

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients [1].
• Acute TFCC injuries require differentiation between those causing distal radioulnar joint (DRUJ) instability and those that do not [2].
• Management of acute TFCC injuries ranges from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
• About 40% of patients sustaining a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
• Arthroscopic-assisted repair techniques provide detailed visualization and facilitate the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5, 6].
• Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes [7].
• TFCC repair achieves good clinical outcomes with low complication rates [11].
• There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair [12].
• There is a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].
• In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period [25].
• TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive [27].

Anatomy & Pathophysiology

• The triangular fibrocartilage complex (TFCC) is a key anatomical structure involved in ulnar-sided wrist pain, alongside distal radioulnar joint (DRUJ) disorders and extensor carpi ulnaris (ECU) tendon disorders [16].
• Ulnar-sided wrist pain often results from a combination of overuse and acute injury, requiring an understanding of sport-specific injuries and underlying biomechanics for effective diagnosis [32].
• Determining the etiology of ulnar-sided wrist pain is challenging due to overlapping history and physical examination findings [38].
• A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative [42].
• Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection [35].
• Deep TFCC fiber tears may contribute to decreased wrist rotational positioning sense [30].
• Deep TFCC fiber tears may have biomechanical importance in distal radioulnar joint stability [30].
• The intensity of pain produced by stressing the wrist in different positions differs between traumatic tears and degenerative wear [41].
• Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction [36].
• Associated ulnar styloid fractures and significant radial translation are predictors of distal radioulnar joint instability in the context of distal radius fractures [48].
• Statistical analysis did not identify a correlation between any single radiographic parameter of distal radius fractures and associated triangular fibrocartilage complex injuries [45].
• Load-bearing radioulnar measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
• Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion [33].
• When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of wrist pain [44].

Classification

• TFCC injuries are differentiated based on whether they cause distal radioulnar joint (DRUJ) instability [2].
• About 40% of patients with a TFCC tear without DRUJ instability still had pain and disability at 1 year [3].
• Type 1B TFCC injury is the most common TFCC injury in patients with distal radius fractures (DRF) [8].
• The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC type 1B injury [10].
• Frykman Type VI and VIII distal radius fractures show a significantly higher incidence of TFCC tears [34].
• The Melone classification system does not predict the presence of TFCC lesions after distal radius fractures [34].
• Classification of central TFCC lesions as traumatic or degenerative depends on information provided upon viewing the lesion at arthroscopy [13].
• Atzei's classification is used for the detailed classification of pc-TFCC tears [21].
• The diagnostic accuracy of MRI for detailed TFCC classifications, such as Atzei's classification, is lower compared to wrist arthroscopy [21].
• A treatment-oriented classification system categorizes five classes of TFCC peripheral tears based on clinical and arthroscopic criteria [28].
• Coexisting type 2 TFCC tears significantly increase the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-side TFCC tears [14].

Clinical Presentation

• Careful history and physical examination are required to determine whether a TFCC tear is symptomatic [9].
• It is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].
• Disability outcomes were worse in patients with distal radial fractures where the TFCC was injured [20].
• The 1B TFCC injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
• The presence of an ulnar styloid fracture associated with a distal radius fracture predicts the presence of traumatic TFCC injury, specifically TFCC 1B injury [10].
• Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy [13].
• Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tears [15].
• MR arthrography is a more sensitive and specific method for the diagnosis of TFCC tears compared to conventional wrist MRI [22].
• Load-bearing radioulnar (RaUl) measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury [18].
• Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, requiring distinction from atypical configuration of the prestyloid recess in CT arthrography [24].
• There is a higher frequency of accompanying extensor carpi ulnaris (ECU) tendon and/or DRUJ disorders in patients with chronic TFCC tears compared to controls [23].
• Damage to the TFCC itself may alter relationships of the DRUJ and the ECU subsheath, or various pathologies causing ulnar-sided wrist pain may drive patients toward surgery [17].

Investigations

• Radiocarpal arthrograms were better at detecting TFCC tears than midcarpal arthrograms [47].
• Midcarpal arthrograms were best for detecting lunotriquetral (LT) tears [47].
• Arthroscopy remains the gold standard for diagnosis [47].
• Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear [15].
• CT arthrography and MR arthrography have statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries [53].
• The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC are consistently higher compared with those of 1.5T wrist MRI [43].
• In detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy [21].
• Ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries on CT arthrography [24].
• Distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist [24].
• The presence of an ulnar styloid fracture associated with distal radius fracture predicts the presence of frequently occurring traumatic TFCC injury and TFCC 1B injury [10].
• TFCC 1B injury is the most common type in patients with distal radius fractures (DRF) and concomitant TFCC injury [8].
• There is a high incidence of TFCC abnormalities on MRI in asymptomatic subjects, particularly those over the age of 50 [51].
• The presence of an abnormal TFCC on MRI may be of questionable clinical meaning due to the high incidence of abnormalities in asymptomatic subjects [51].

Treatment

Non-Operative Management

• Nonsurgical treatment is moderately successful for treating patients with TFCC tears without distal radioulnar joint (DRUJ) instability [31].
• Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation [46].

Operative Management: Indications and Selection

• Acute TFCC injuries require differentiation between those causing DRUJ instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability [2].
• Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary [9].

Operative Management: Surgical Techniques and Approaches

• Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques [5].
• Open and arthroscopic techniques are available for TFCC injuries [4].

Operative Management: Outcomes by Technique

• Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates [11].
• A systematic review demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears [19].

Operative Management: Specific Populations and Pathologies

• Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears [29].
• Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients with peripheral ulnar-side TFCC tears [14].
• The combined extensor retinaculum capsulorrhaphy and suture repair effectively restores stability to both the DRUJ and ulnocarpal joint (UCJ) in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion [37].

Complications

• Approximately 40% of patients sustaining a TFCC tear without distal radioulnar joint instability (DRUJ) instability still had pain and disability at 1 year [3].
• Coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in patients undergoing arthroscopic repair of peripheral ulnar-sided TFCC tears [14].

Recovery

• TFCC capsular reattachment performed with an arthroscopically assisted technique provides good long-term results [26].
• Disability outcomes were worse in patients with distal radial fracture where TFCC was injured [20, 52].
• In the first year after open TFCC reinsertion, 91% of patients returned to work, including 50% within 12 weeks [54].
• About 40% of patients sustaining TFCC tear without distal radioulnar joint instability still had pain and disability at 1 year [3].

Key Evidence

• [L4] Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. [1] (10.1016/j.jhsa.2019.06.019)
• [L5] Acute TFCC injuries require differentiation between those causing distal radioulnar joint instability and those that do not, with management ranging from nonsurgical immobilization to arthroscopic or open surgical repair depending on the specific injury pattern and stability. [2] (10.5435/00124635-200806000-00004)
• [L4] About 40% of patients sustaining TFCC tear without DRUJ instability still had pain and disability at 1 year. [3] (10.1016/j.jhsa.2018.06.064)
• [L5] The article reviews diagnosis, classification, and treatment options including open and arthroscopic techniques for TFCC injuries. [4] (10.1016/j.hcl.2010.07.003)
• [L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [5] (10.1016/j.jhsg.2025.100857)
• [L5] Arthroscopic-assisted repair techniques have revolutionized surgical management, providing detailed visualization and facilitating the repair of TFCC injuries and associated pathologies with minimally invasive techniques. [6] (10.1016/j.jhsg.2024.03.011)
• [L4] Arthroscopic treatment of TFCC lesions leads to satisfactory functional outcomes. [7] (10.1055/s-0039-3400454)
• [L3] 1B TFCC injury is most common in patients with DRF and concomitant TFCC injury. [8] (10.1186/s13018-023-04438-5)
• [L4] Careful history and physical examination are required to determine whether a TFCC tear is symptomatic, and it is important to quantify the severity of symptoms related to TFCC pathology to determine whether surgical treatment is necessary. [9] (10.5435/jaaos-d-20-00998)
• [L4] The presence of ulnar styloid fracture associated with distal radius fracture predicted the presence of frequently occurring traumatic triangular fibrocartilage complex injury and TFCC 1B injury. [10] (10.1016/j.arthro.2020.05.025)
• [L4] Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. [11] (10.1055/s-0040-1718913)
• [L3] There was no statistical difference in clinical outcomes after open versus arthroscopic TFCC repair. [12] (10.1016/j.jhsa.2008.01.020)
• [L2] Classification of central triangular fibrocartilage complex lesions as traumatic or degenerative depends on the information provided upon viewing the lesion at arthroscopy. [13] (10.1177/1753193416684658)
• [L4] However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients. [14] (10.1016/j.arthro.2020.05.012)
• [L4] Arthroscopy is effective in obtaining both correct diagnosis and treatment of peripheral TFCC tear. [15] (10.2174/1874325001711010525)
• [L5] The article provides a concise approach to the diagnosis and imaging of ulnar-sided wrist pain, discussing anatomy, pathophysiology, and radiographic appearance of common entities including TFCC tears, DRUJ disorders, and ECU tendon disorders. [16] (10.1016/j.csm.2006.02.008)
• [L3] This may be due to the damage to the TFCC itself altering relationships of the DRUJ and the ECU subsheath, or it may reflect various pathologies that cause ulnar-sided wrist pain and drive patients toward surgery. [17] (10.1177/1558944720937369)
• [L2] Load-bearing RaUl measurement is a simple method to diagnose an unstable distal radioulnar joint in patients with TFCC injury. [18] (10.1016/j.jhsa.2022.01.008)
• [L4] This SR demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears. [19] (10.1177/1558944718815244)
• [L2] Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. [20] (10.1016/j.jht.2017.09.002)
• [L4] In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. [21] (10.1186/s12891-023-07140-z)
• [L3] MR arthrography is more sensitive and specific method in terms of the diagnosis of TFCC tears compared to conventional wrist MRI. [22] (10.1016/j.injury.2019.07.032)
• [L3] We found a higher frequency of accompanying ECU tendon and/or DRUJ disorders in patients with chronic TFCC tears as compared to the control group. [23] (10.1016/j.jhsa.2016.07.040)
• [L4] Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist. [24] (10.1186/s12891-022-05241-9)
• [L4] In high-demand athletes, arthroscopic repair of TFCC tears is becoming the treatment of choice to obtain optimum physiologic strength, complete range of motion, stability, and the shortest possible postoperative period. [25] (10.1016/j.hcl.2009.05.011)
• [L5] TFCC capsular reattachment could be performed with an arthroscopically assisted technique, providing good long-term results. [26] (10.1016/j.hcl.2017.06.005)
• [L4] TFCC repair varies substantially from surgeon-to-surgeon, suggesting repairs are discretionary and preference sensitive. [27] (10.1055/s-0038-1625953)
• [L2] The classification highlights clinical and arthroscopic criteria to categorize five classes of TFCC peripheral tears on a treatment-oriented system. [28] (10.1177/1753193416687479)
• [L3] Arthroscopic debridement alone appears to be an effective and safe initial treatment for patients with traumatic central TFCC tears. [29] (10.1302/0301-620x.106b4.bjj-2023-0642.r3)
• [L3] Deep TFCC fiber tear may contribute to decreased wrist rotational positioning sense and may have biomechanical importance in distal radioulnar joint stability. [30] (10.1016/j.jhsa.2018.01.022)
• [L3] Nonsurgical treatment is moderately successful for treating patients with TFCC tears without DRUJ instability. [31] (10.1097/corr.0000000000000533)
• [L5] Ulnar-sided wrist pain in athletes is a common problem often resulting from a combination of overuse and acute injury, requiring careful understanding of sport-specific injuries and underlying biomechanics for effective diagnosis and treatment. [32] (10.1016/j.csm.2019.12.008)
• [L4] Dynamic CT imaging shows promise for evaluating the distal radioulnar joint during wrist motion. [33] (10.1177/17531934251397297)
• [L3] The Melone classification system does not predict the presence of TFCC lesions, while Frykman Type VI and VIII fractures show a significantly higher incidence of TFCC tears. [34] (10.1177/1753193408090106)
• [L5] Distal radioulnar joint instability is often an underestimated lesion requiring systematic clinical examination and imaging for detection. [35] (10.1007/s00402-020-03371-0)
• [L5] Distal radius fractures are common pediatric injuries with significant remodeling potential depending on age and deformity direction. [36] (10.1016/j.hcl.2005.09.002)
• [L4] The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. [37] (10.1016/j.jhsg.2025.100806)
• [L5] Determining the etiology of ulnar-sided wrist pain is often challenging due to overlapping history and physical examination findings; a detailed history, systematic physical examination with provocative maneuvers, and appropriate diagnostic imaging are essential for diagnosis. [38] (10.5435/jaaos-d-16-00407)
• [L3] The intensity of pain produced by stressing the wrist in different positions was different between a traumatic tear and degenerative wear. [41] (10.1177/1753193410377838)
• [L4] A systematic approach to evaluating patients with ulnar-sided wrist pain is imperative. [42] (10.1016/j.jhsa.2014.07.004)
• [L3] The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI, suggesting improved capability for detection of TFCC injuries. [43] (10.1016/j.jhsa.2008.02.028)
• [L2] When the appropriate pulse sequence is used, magnetic resonance imaging is an accurate and effective method for the non-invasive evaluation of pain in the wrist. [44] (10.2106/00004623-199711000-00009)
• [L3] Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. [45] (10.1177/1753193415624669)
• [L3] Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. [46] (10.1302/0301-620x.103b8.bjj-2020-2310.r2)
• [L4] Radiocarpal arthrograms were better at detecting TFCC tears and midcarpal arthrograms were best for detecting LT tears, with arthroscopy remaining the gold standard. [47] (10.1016/j.arthro.2020.12.108)
• [L3] Associated ulnar styloid fractures and significant radial translation are predictors of DRUJ instability. [48] (10.1055/s-0034-1365825)
• [L3] The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. [51] (10.1016/j.jhsa.2011.10.006)
• [L2] Disability outcomes were worse in patients with distal radius fracture where TFCC was injured. [52] (10.1016/j.jht.2017.09.012)
• [L1] CTA and MRA had statistically equivalent sensitivity and specificity for the diagnosis of TFCC injuries. [53] (10.1055/s-0038-1629911)
• [L3] In the first year after open TFCC reinsertion, 91% of the patients returned to work, including 50% within 12 weeks. [54] (10.1016/j.hansur.2021.03.012)

References

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[2] Management of Acute Triangular Fibrocartilage Complex Injury of the Wrist. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200806000-00004

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[34] The Value of Plain X-Rays in Predicting TFCC Injury after Distal Radial Fractures. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408090106

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[41] The Relationship Between Stress Positions and Pain Intensity in Triangular Fibrocartilage Lesions. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193410377838

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[43] Diagnostic Comparison of 1.5 Tesla and 3.0 Tesla Preoperative MRI of the Wrist in Patients With Ulnar-Sided Wrist Pain. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.02.028

[44] The Utility of High-Resolution Magnetic Resonance Imaging in the Evaluation of the Triangular Fibrocartilage Complex of the Wrist. The Journal of Bone and Joint Surgery (American Volume)*. 1997. DOI: 10.2106/00004623-199711000-00009

[45] The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415624669

[46] Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b8.bjj-2020-2310.r2

[47] Evaluation of Diagnostic Procedures for Ulnar Sided Wrist Pain: 25 Years of Experience. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.108

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[51] Prevalence of Triangular Fibrocartilage Complex Abnormalities on MRI Scans of Asymptomatic Wrists. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.10.006

[52] Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2017.09.012

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