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Carratalá V, Lucas FJ, Miranda I, Martínez C, Guisasola E. All-Arthroscopic Triangular Fibrocartilage Complex Ligamentoplasty: Technique and Results. J Wrist Surg 2023; 12:104-112. [PMID: 36926213 PMCID: PMC10010905 DOI: 10.1055/s-0042-1757765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study is to describe the modified all-arthroscopic technique for triangular fibrocartilage complex (TFCC) ligamentoplasty in chronic injuries of the TFCC with distal radioulnar joint (DRUJ) instability, and to present the results obtained. Methods A prospective study was conducted including 11 consecutive patients with chronic TFCC injury with DRUJ instability who underwent an all-arthroscopic TFCC ligamentoplasty. During follow-up, the range of joint motion, grip strength, pain according to the visual analog scale (VAS), functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were measured, and any complications and necessary reinterventions were recorded Results We analyzed 11 patients with distal radioulnar ligament injury treated using the all-arthroscopic ligamentoplasty technique. Mean follow-up was 31.5 ± 4.4 (range 12-58) months. The technique presented achieved DRUJ stability in 100% of cases at 12 months. Grip strength and pain, showed a statistically significant improvement between the preoperative score and the two postoperative assessments. Functional assessment using the QuickDASH score and the MWS also improved significantly. Conclusion The all-arthroscopic technique for the reconstruction of irreparable peripheral TFCC tears is a reliable technique, intended not only to minimize the surgical trauma to reduce postoperative pain and to facilitate rehabilitation, but also to improve both the quality of the reconstruction and the functional outcome.
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Affiliation(s)
- Vicente Carratalá
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
| | | | | | - Cristóbal Martínez
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
- Traumaunit, Teknon Clinic, Barcelona, Spain
| | - Eva Guisasola
- Hand and Upper Limb Surgery Unit, Hospital Quirónsalud Valencia, Valencia, Spain
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Ng WHA, Griffith JF, Ng ISH. How to Report: Wrist MRI. Semin Musculoskelet Radiol 2021; 25:670-680. [PMID: 34861712 DOI: 10.1055/s-0041-1736313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Knowledge of the imaging anatomy of the wrist is essential for reporting magnetic resonance imaging (MRI). This familiarity should include the carpal bones, tendons (extensor and flexor compartments), triangular fibrocartilage complex (TFCC), intrinsic and extrinsic ligaments, and nerves, especially the median and ulnar nerves. Limitations of MRI in visualizing these structures, particularly the intrinsic ligaments and the TFCC, need to be considered. This article outlines the main features to comment on when reporting common conditions of the wrist on MRI, with some examples of terminology that can be used to describe these abnormalities.
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Affiliation(s)
- Wing Hung Alex Ng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - James Francis Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
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Terzis A, Klinger A, Seegmüller J, Sauerbier M. Inter-Rater Reliability of Magnetic Resonance Imaging in Comparison to Computed Tomography and Wrist Arthroscopy in SLAC and SNAC Wrist. J Clin Med 2021; 10:3592. [PMID: 34441890 PMCID: PMC8397217 DOI: 10.3390/jcm10163592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to assess the inter-rater reliability of magnetic resonance imaging (MRI) in comparison to computed tomography (CT) and wrist arthroscopy in patients with scapholunate (SLAC) or scaphoid non-union advanced collapse (SNAC) as well as to evaluate a grading score of cartilage lesions. A total of 42 patients (36 male, 6 female) at a mean age of 45 years (range: 19-65 years) with a SLAC or SNAC wrist who had a preoperative MRI and CT scan as well as underwent arthroscopy of the wrist between 2013 and 2018 were included in this study. Cartilage lesions, as assessed by MRI, CT and wrist arthroscopy, were classified by two hand surgeons in three stages. Inter-rater reliability was evaluated using the Kendall Tau-b test as well as the chi-square test to analyze for trend. The correlation between cartilage lesions, classified by arthroscopy and MRI, was low. A moderate correlation between CT and arthroscopy staging was shown. The highest inter-rater correlation was found between MRI and CT staging. An additionally performed logistic regression showed that progression of cartilage lesions as shown in MRI scans correlates with a restriction of range of motion (ROM). The level of cartilage lesion may be more severely classified in an MRI than during arthroscopy. Arthroscopy remains the gold standard in detecting cartilage lesions and thus in the decision-making process of the definitive treatment in carpal collapse.
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Affiliation(s)
- Athanasios Terzis
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Arlena Klinger
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Jessica Seegmüller
- Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (A.K.); (J.S.)
| | - Michael Sauerbier
- Private Practice for Hand and Plastic Surgery, 61348 Bad Homburg v. d. Höhe, Germany;
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Sivak WN, Imbriglia JE. Evaluation of Cartilage in the Wrist using Magnetic Resonance Imaging. Curr Rheumatol Rev 2019; 16:170-177. [PMID: 31804162 DOI: 10.2174/1573397115666190819153912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/18/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022]
Abstract
Wrist pain is a common patient complaint with a myriad of clinical conditions that can explain the underlying cause. Short of wrist arthroscopy, no technique other than formal wrist arthrotomy exists for direct examination of the hyaline cartilage coating the articular surfaces of the carpal bones. Magnetic resonance imaging (MRI) has been proven accurate in evaluating joint surfaces of large joints such as the shoulder, hip, and knee with articular cartilage surface thickness is in excess of 1 mm. However, in the carpus the thickness of the cartilage and the contours present have precluded accurate imaging. Advances in MRI technology over the last several decades are now making imaging of small joint surfaces, such as the carpus, an area worth revisiting. Herein we provide a review of these efforts with a specific focus on the evaluation of the wrist.
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Affiliation(s)
- Wesley N Sivak
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joseph E Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 2014; 15:4. [PMID: 24397703 PMCID: PMC3893587 DOI: 10.1186/1471-2474-15-4] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 01/02/2014] [Indexed: 02/08/2023] Open
Abstract
Background Musculoskeletal disorders of the upper extremity are common reasons for patients to seek care and undergo ambulatory surgery. The objective of our study was to assess the overall and age-adjusted utilization rates of rotator cuff repair, shoulder arthroscopy performed for indications other than rotator cuff repair, carpal tunnel release, and wrist arthroscopy performed for indications other than carpal tunnel release in the United States. We also compared demographics, indications, and operating room time for these procedures. Methods We used the 2006 National Survey of Ambulatory Surgery to estimate the number of procedures of interest performed in the United States in 2006. We combined these data with population size estimates from the 2006 U.S. Census Bureau to calculate rates per 10,000 persons. Results An estimated 272,148 (95% confidence intervals (CI) = 218,994, 325,302) rotator cuff repairs, 257,541 (95% CI = 185,268, 329,814) shoulder arthroscopies excluding those for cuff repairs, 576,924 (95% CI = 459,239, 694,609) carpal tunnel releases, and 25,250 (95% CI = 17,304, 33,196) wrist arthroscopies excluding those for carpal tunnel release were performed. Overall, carpal tunnel release had the highest utilization rate (37.3 per 10,000 persons in persons of age 45–64 years; 38.7 per 10,000 persons in 65–74 year olds, and; 44.2 per 10,000 persons in the age-group 75 years and older). Among those undergoing rotator cuff repairs, those in the age-group 65–74 had the highest utilization (28.3 per 10,000 persons). The most common indications for non-cuff repair related shoulder arthroscopy were impingement syndrome, periarthritis, bursitis, and instability/SLAP tears. Non-carpal tunnel release related wrist arthroscopy was most commonly performed for ligament sprains and diagnostic arthroscopies for pain and articular cartilage disorders. Conclusions Our data shows substantial age and demographic differences in the utilization of these commonly performed upper extremity ambulatory procedures. While over one million upper extremity procedures of interest were performed, evidence-based clinical indications for these procedures remain poorly defined.
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Affiliation(s)
- Nitin B Jain
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA, USA.
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Hayter CL, Gold SL, Potter HG. Magnetic resonance imaging of the wrist: Bone and cartilage injury. J Magn Reson Imaging 2013; 37:1005-19. [DOI: 10.1002/jmri.23845] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 08/29/2012] [Indexed: 01/13/2023] Open
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Foumani M, Strackee SD, van de Giessen M, Jonges R, Blankevoort L, Streekstra GJ. In-vivo dynamic and static three-dimensional joint space distance maps for assessment of cartilage thickness in the radiocarpal joint. Clin Biomech (Bristol, Avon) 2013; 28:151-6. [PMID: 23218255 DOI: 10.1016/j.clinbiomech.2012.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 11/04/2012] [Accepted: 11/06/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The assessment of the joint space thickness is an important clinical parameter for diagnosing osteoarthritis. The accuracy of joint space thickness evaluation from radiographs is limited due to anatomical complexity of the wrist. We propose using distance maps estimated from 3-dimensional and 4-dimensional images reflecting joint space thickness distribution over the relevant part of the articular surface. METHODS In this paper we investigate the difference between joint space thicknesses acquired from dynamic distance maps to static distance maps. A dynamic distance map gives for every point on a subchondral bone surface the shortest distance to the opposing subchondral bone surface during wrist motion. We hypothesize that the joint space thickness calculated from dynamic distance maps provide a better reflection of the functional joint space thickness. The diagnostic potential of the dynamic joint space thickness measurement is illustrated by comparing data from distance maps of osteoarthritic wrists with normal wrists. FINDINGS In 10 healthy wrists which are examined, dynamic joint space thickness is smaller than static acquired joint space thickness suggesting that dynamic distance maps provide a better estimate of the measured joint space thickness than joint space thickness based on a static joint space thickness. In 3 examined osteoarthritic wrists the joint space thickness is smaller than in healthy individuals. Moreover, the difference between dynamic and static joint space thickness is smaller in pathological joint parts. INTERPRETATION The method presented in this paper demonstrates the feasibility of in vivo dynamic distance maps to detect joint space thickness in the radiocarpal joint of healthy individuals.
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Affiliation(s)
- M Foumani
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Meibergdreef 9, Suite G4-226, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Menashe L, Hirko K, Losina E, Kloppenburg M, Zhang W, Li L, Hunter DJ. The diagnostic performance of MRI in osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2012; 20:13-21. [PMID: 22044841 PMCID: PMC3934362 DOI: 10.1016/j.joca.2011.10.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 09/02/2011] [Accepted: 10/03/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is currently diagnosed using clinical and radiographic findings. In recent years magnetic resonance imaging (MRI) use in OA has increasingly been studied. This study was conducted to determine the diagnostic utility of MRI in OA through a meta-analysis of published studies. METHODS A systematic literature search was undertaken to include studies that used MRI to evaluate or detect OA. MRI was compared to various reference standards: histology, arthroscopy, radiography, CT, clinical evaluation, and direct visual inspection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) area under the curve (AUC) were calculated. Random-effects models were used to pool results. RESULTS Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of 1220 patients (1071 with OA and 149 without). Overall sensitivity from pooling data of all the included studies was 61% [95% confidence interval (CI) 53-68], specificity was 82% (95% CI 77-87), PPV was 85% (95% CI 80-88), and NPV was 57% (95% CI 43-70). The ROC showed an AUC of 0.804. There was significant heterogeneity in the above parameters (I(2)>83%). With histology as the reference standard, sensitivity increased to 74% and specificity decreased to 76% compared with all reference standards combined. When arthroscopy was used as the reference standard, sensitivity increased to 69% and specificity to 93% compared with all reference standards combined. CONCLUSION MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. The sensitivity of MRI is below the current clinical diagnostic standards. At this time standard clinical algorithm for OA diagnosis, aided by radiographs appears to be the most effective method for diagnosing OA.
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Affiliation(s)
- Leo Menashe
- Tufts University School of Medicine, Boston MA ,Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - Kelly Hirko
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - Elena Losina
- Department of Orthopedic Surgery, Brigham and Women’s
Hospital, Department of Biostatistics, Boston University School of Public Health,
Boston, MA USA.
| | | | - Weiya Zhang
- Academic Rheumatology, the University of Nottingham, Clinical
Sciences Building, Nottingham City Hospital, Nottingham NG5, 1PB, United Kingdom
| | - Ling Li
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120.
| | - David J. Hunter
- Division of Research, New England Baptist Hospital, 125 Parker Hill
Ave Boston MA 02120. ,Northern Clinical School, The University of Sydney, Sydney,
Australia.
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Stevens KJ, Wallace CG, Chen W, Rosenberg JK, Gold GE. Imaging of the wrist at 1.5 Tesla using isotropic three-dimensional fast spin echo cube. J Magn Reson Imaging 2011; 33:908-15. [PMID: 21448957 DOI: 10.1002/jmri.22494] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To compare three-dimensional fast spin echo Cube (3D-FSE-Cube) with conventional 2D-FSE in MR imaging of the wrist. MATERIALS AND METHODS The wrists of 10 volunteers were imaged in a 1.5 Tesla MRI scanner using an eight-channel wrist coil. The 3D-FSE-Cube images were acquired in the coronal plane with 0.5-mm isotropic resolution. The 2D-FSE images were acquired in both coronal and axial planes for comparison. An ROI was placed in fluid, cartilage, and muscle for SNR analysis. Comparable coronal and axial images were selected for each sequence, and paired images were randomized and graded for blurring, artifact, anatomic details, and overall image quality by three blinded musculoskeletal radiologists. RESULTS SNR of fluid, cartilage and muscle at prescribed locations were higher using 3D-FSE-Cube, without reaching statistical significance. Fluid-cartilage CNR was also higher with 3D-FSE-Cube, but not statistically significant. Blurring, artifact, anatomic details, and overall image quality were significantly better on coronal 3D-FSE-Cube images (P < 0.001), but significantly better on axial 2D-FSE images compared with axial 3D-FSE-Cube reformats (P < 0.01). CONCLUSION Isotropic data from 3D-FSE-Cube allows reformations in arbitrary scan planes, which may make multiple 2D acquisitions unnecessary, and improve depiction of complex wrist anatomy. However, axial reformations suffer from blurring, likely due to T2 decay during the long echo train, limiting overall image quality in this plane.
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Rosas HG, Tuite MJ. The current state of imaging the articular cartilage of the upper extremity. Magn Reson Imaging Clin N Am 2011; 19:407-23. [PMID: 21665097 DOI: 10.1016/j.mric.2011.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
MR imaging has increasingly been used to image joints since its inception. Historically, there has been more emphasis on the evaluation of internal derangement rather than cartilaginous disease. This article reviews cartilaginous diseases of the upper extremity emphasizing those that can be assessed using current clinical MR imaging protocols and addresses the limitations of current imaging techniques in evaluating the articular cartilage of smaller joints. It also provides a brief overview of novel techniques that may be instituted in the future to improve the diagnostic performance of MR imaging in the evaluation of the articular cartilage of the upper extremity.
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Affiliation(s)
- Humberto G Rosas
- Musculoskeletal Radiology, Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Hospital and Clinics, F2/422, 600 Highland Avenue, Madison, WI 53792, USA.
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Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage 2011; 19:557-88. [PMID: 21396463 PMCID: PMC3268360 DOI: 10.1016/j.joca.2010.10.029] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/14/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change. METHODS An online literature search was conducted of the OVID, EMBASE, CINAHL, PsychInfo and Cochrane databases of articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance by two reviewers. Of these, 243 were selected for data extraction for this analysis on validity as well as separate reviews on discriminate validity and diagnostic performance. Of these 142 manuscripts included data pertinent to concurrent validity and 61 manuscripts for the predictive validity review. For this analysis we extracted data on criterion (concurrent and predictive) validity from both longitudinal and cross-sectional studies for all synovial joint tissues as it relates to MRI measurement in OA. RESULTS Concurrent validity of MRI in OA has been examined compared to symptoms, radiography, histology/pathology, arthroscopy, CT, and alignment. The relation of bone marrow lesions, synovitis and effusion to pain was moderate to strong. There was a weak or no relation of cartilage morphology or meniscal tears to pain. The relation of cartilage morphology to radiographic OA and radiographic joint space was inconsistent. There was a higher frequency of meniscal tears, synovitis and other features in persons with radiographic OA. The relation of cartilage to other constructs including histology and arthroscopy was stronger. Predictive validity of MRI in OA has been examined for ability to predict total knee replacement (TKR), change in symptoms, radiographic progression as well as MRI progression. Quantitative cartilage volume change and presence of cartilage defects or bone marrow lesions are potential predictors of TKR. CONCLUSION MRI has inherent strengths and unique advantages in its ability to visualize multiple individual tissue pathologies relating to pain and also predict clinical outcome. The complex disease of OA which involves an array of tissue abnormalities is best imaged using this imaging tool.
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Work-Up of the Arthritic Wrist. Tech Orthop 2009. [DOI: 10.1097/bto.0b013e3181a07f19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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