Current perspectives in conventional and advanced imaging of the distal radioulnar joint dysfunction: review for the musculoskeletal radiologist

Based on anatomic and biomechanical studies and review of our clinical experience of the past 10 years, a classification of injuries to the triangular fibrocartilage complex is presented. This classification is based on the clinical examination, routine x-ray films, wrist arthrograms, wrist arthroscopy, and wrist arthrotomy. The classification recognizes both traumatic and degenerative lesions. Traumatic lesions are classified according to their location. Degenerative lesions are classified by the location and severity of degenerative changes of the triangular fibrocartilage complex, ulnar head, ulnocarpal bones and lunotriquetral ligament.

Advances in radiocarpal and distal radioulnar joint (DRUJ) diagnostic arthroscopy permits a treatment-oriented classification of triangular fibrocartilage complex (TFCC) peripheral tears: 1) repairable distal tears; 2) repairable complete tears; 3) repairable proximal tears; 4) non-repairable tears; and 5) tears associated with DRUJ arthritis. Class 1 tears should be sutured; Class 2 and 3 are associated with DRUJ instability and require TFCC reattachment to the fovea; Class 4 tears need reconstruction using a tendon graft and Class 5 tears require an arthroplasty. Arthroscopic assisted TFCC foveal reattachment is possible through the direct foveal portal, a dedicated DRUJ working portal. Arthroscopic TFCC reconstruction using a tendon graft showed promising results.