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J Wrist Surg 2022; 11(01): 028-034
DOI: 10.1055/s-0041-1729757
Scientific Article

Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex

Sergio De Santis
1   Hand Surgery Unit, Gaetano Pini, Milano, Italy
,
Roberto Cozzolino
2   Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
,
Riccardo Luchetti 
2   Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
,
Lucia Cazzoletti
3   Department of Diagnostics and Public Health, Section of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
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Abstract

Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis.

Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection.

Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I–III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings.

Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases.

Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage.

Level of Evidence This is a Level II, retrospective comparative study.

Keywords

wrist arthroscopy - wrist MRI - wrist ligament injury - wrist sprain - scapholunate ligament injury - TFCC ligament injury

Note

The work was performed at the Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy.




Publication History

Received: 29 November 2020

Accepted: 29 March 2021

Article published online:
11 May 2021

© 2021. Thieme. All rights reserved.

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