Purpose
To investigate the diagnostic performance of magnetic resonance imaging (MRI) and
clinical provocative tests on injuries to the triangular fibrocartilage complex (TFCC),
the scapholunate (SL) ligament, and the lunotriquetral (LT) ligament.
Methods
An electronic literature search of articles published between January 1, 2000, and
February 28, 2014, in PubMed, Embase, and the Cochrane Library was carried out in
April 2014. Only studies of the diagnostic performance of MRI and clinical provocation
tests using wrist arthroscopy as the gold standard were eligible for inclusion. The
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist
guided the extraction and reporting of data. The methodologic quality of the included
articles was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies
(QUADAS-2) tool. The primary outcome measure was the negative predictive value (NPV)
of wrist MRI and provocative wrist tests, which was defined as the probability of
an intact wrist ligament given a negative investigation. The question was whether
negative results of MRI or provocative tests were enough to safely discontinue further
investigation with arthroscopy. A minimum NPV of 95% was considered a clinically relevant
cutoff value. The secondary outcome measures were the positive predictive value (PPV),
sensitivity, and specificity.
Results
A total of 7 articles (327 patients with MRI and 105 patients with clinical tests)
were included in this systematic review. The included articles displayed heterogeneity
regarding participants, diagnostic methods, and study design. Seven articles investigated
the diagnostic performance of MRI, whereas 1 article investigated clinical testing.
The NPVs of MRI were as follows: TFCC, 37% to 90%; SL ligament, 72% to 94%; and LT
ligament, 74% to 95%. The NPVs of clinical tests were 55%, 74%, and 94% for the TFCC,
SL ligament, and LT ligament, respectively. Only 1 study reached the predetermined
cutoff value for the primary outcome measure (NPV ≥95%) but only for MRI of the LT
ligament; this study also reached a borderline-cutoff NPV of 94% for MRI of the SL
ligament. Another study reached borderline-cutoff NPVs of 94% both for MRI and for
clinical tests of the LT ligament.
Conclusions
A negative result from MRI is unable to rule out the possibility of a clinically relevant
injury to the TFCC, SL ligament, or LT ligament of the wrist. Clinical provocation
wrist tests were of limited diagnostic value. The current gold standard—wrist arthroscopy—remains
the preferred diagnostic technique with sufficient conclusive properties when it comes
to wrist ligament injuries.
Level of Evidence
Level II, systematic review of Level II diagnostic studies.
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References
- Magnetic resonance imaging of the wrist: Diagnostic performance statistics.Clin Radiol. 2001; 56: 50-57
- Assessment of scapholunate instability and review of evidence for management in the absence of arthritis.J Hand Surg Eur. 2013; 38: 727-738
- Distal radial fractures and effects of associated ligament injuries.Department of Orthopedics, Lund University Hospital, Lund, Sweden, Lund2000 (dissertation)
- Wrist ligament injuries—Diagnostics.Lakartidningen. 2011; 42 ([in Swedish]): 2096-2101
- Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius.J Bone Joint Surg Am. 1996; 78: 357-365
- Arthroscopic diagnosis of intra-articular soft tissue injuries associated with distal radial fractures.J Hand Surg Am. 1997; 22: 772-776
- Clinical assessment of the wrist.in: Cooney III, W.P. The wrist: Diagnosis and operative treatment. Ed 2. Lippincott Williams & Wilkins, Philadelphia2010: 119-150
- Carpal instability.in: Green D.P. Hotchkiss R.N. Pederson W.C. Wolfe S.W. Green's operative hand surgery. Ed 5. Elsevier Churchill Livingstone, Philadelphia2005: 535-604
- The “ulnar fovea sign” for defining ulnar wrist pain: An analysis of sensitivity and specificity.J Hand Surg Am. 2007; 32: 438-444
- The natural course of traumatic triangular fibrocartilage complex tears in distal radial fractures: A 13-15 year follow-up of arthroscopically diagnosed but untreated injuries.J Hand Surg Am. 2012; 37: 1555-1560
- Clinical provocative tests used in evaluating wrist pain: A descriptive study.J Hand Ther. 1995; 8: 10-17
- Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement.J Clin Epidemiol. 2009; 62: 1006-1012
- QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies.Ann Intern Med. 2011; 155: 529-536
- Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex?.J Hand Surg Br. 2000; 25: 487-491
- Magnetic resonance imaging for diagnosing lesions of the triangular fibrocartilage complex.Acta Orthop Belg. 2005; 71: 396-398
- Partial interosseous ligament tears of the wrist: Difficulty in utilizing either primary or secondary MRI signs.J Comput Assist Tomogr. 2001; 25: 671-676
- Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears.AJR Am J Roentgenol. 2009; 192: 80-85
- The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions.J Hand Surg Am. 2001; 26: 742-748
- A comparison of the findings of wrist arthroscopy and magnetic resonance imaging in the investigation of wrist pain.J Hand Surg Br. 2001; 26: 544-546
- Provocative wrist tests and MRI are of limited diagnostic value for suspected wrist ligament injuries: A cross-sectional study.J Physiother. 2011; 57: 247-253
- Triangular fibrocartilage complex lesions: A classification.J Hand Surg Am. 1989; 14: 594-606
- Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury.J Hand Surg Am. 2006; 31: 1308-1314
- Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: Comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T.Magn Reson Imaging. 2013; 31: 221-226
- Dorsal scapholunate ligament injury: A classification of clinical forms.J Hand Surg Eur. 2013; 38: 165-169
- Intra- and interobserver reliability of digitally photodocumented findings in wrist arthroscopy.Handchir Mikrochir Plast Chir. 2010; 42: 287-292
- Arthroscopic findings in wrist with severe post-traumatic pain despite normal standard radiographs.J Hand Surg Br. 2004; 29: 208-213
- Distal radio-ulnar joint instability in children and adolescents after wrist trauma.J Hand Surg Eur. 2014; 39: 653-661
- Wrist arthroscopy in children and adolescents: A single surgeon experience of thirty-four cases.Int Orthop. 2012; 36: 1215-1220
Article info
Publication history
Published online: June 18, 2015
Accepted:
April 17,
2015
Received:
February 17,
2015
Footnotes
See commentary on page 2021
This investigation conforms with the University of Gothenburg Human Research Protection Programme guidelines.
The authors report the following potential conflict of interest or source of funding: Funding for this project was provided by Sahlgrenska University Hospital and the University of Gothenburg.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Regarding “Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review”ArthroscopyVol. 31Issue 10
- PreviewIt was with great interest that we read the article “Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review” by Andersson et al.1 It is a well-conducted review. We agree completely with the conclusion that wrist arthroscopy remains the reference standard for diagnosing triangular fibrocartilage complex (TFCC) and intercarpal ligament lesions.
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