PROJECT PARTNERS
· Amsterdam Movement Sciences (AMS) research institute
FUNDING
None
BACKGROUND
The triangular fibrocartilage complex (TFCC) is a soft tissue structure located between the distal ulna and carpal bones that provides distal radioulnar joint (DRUJ) stability, ulnocarpal stability, axial load distribution and enables complex movements of the wrist. Injury to this structure, chronic or acute, is considered a common cause of ulnar sided wrist pain.
Magnetic resonance imaging (MRI) is increasingly being used to diagnose TFCC injury based on signal intensity changes. However, the meaning of these signal changes is being questioned since high prevalence rates (38% up to 70%) of abnormal signal intensities are reported in asymptomatic subjects. In elite tennis players, no statistical difference in TFCC abnormalities on MRI was even found between symptomatic, asymptomatic and healthy control subjects. This implies that a substantial amount of signal abnormalities on MRI might not be associated with clinical symptoms.
Meanwhile, surgical intervention in children with suspected TFCC injury has become more prevailing. Multiple studies on surgical techniques and outcomes of wrist arthroscopy in children with TFCC injury have been published recently. Also, shorter immobilization and earlier intervention in young elite athletes with TFCC injury is encouraged in order to facilitate a more rapid return to sport, while the meaning of TFCC signal changes on MRI for this young patient group remains unclear.
OBJECTIVES
The aim of the study is to redefine the normal TFCC by studying the fetal morphologic TFCC development and systematically assessing the normal TFCC appearance on MRI in asymptomatic children and young gymnasts. By acquiring more knowledge on the normal TFCC, a better distinction can be made between pathologic and non-pathologic TFCC variations seen on diagnostic MRI and benefit the decision-making process for treatment. In order to do so, fetal TFCC development will be analyzed in a 3-dimensional manner and correlated with imaging. Also, a systematic score form will be developed and used to study normal TFCC appearance on MRI in healthy children and possible pre-pathological TFCC changes in young gymnasts. Additionally, a new MRI technique will be used to assess TFCC’s in healthy young adults, in order to study its feasibility to improve diagnostic accuracy of detecting TFCC pathology in the future.