To the Editor:
It 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.
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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.It is of notice that all referred studies were performed under optimal circumstances, that is, use of wrist coils, highly trained and specialized musculoskeletal radiologists, and minimum accuracy of standard-resolution 1.5-T magnetic resonance imaging (MRI). We evaluated the findings of 401 externally performed MRI scans and correlated the former findings to our wrist arthroscopies. Our findings showed an average specificity of 60% and sensitivity of 69% regarding TFCC lesions.
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Our study showed that hand surgeons have to deal with many different MRI protocols that are mostly not specifically designed for this anatomic region and this reduces the diagnostic efficacy. Furthermore, most radiologists were not specialized. Therefore, we rely on our standardized clinical examination protocol and, in accordance to that, perform wrist arthroscopy if necessary.3
MRI arthrography might be a promising tool in the future, but its widespread use has not been facilitated yet. Even though wrist arthroscopy remains the reference standard for TFCC and intercarpal ligament lesions, the intraobserver and interobserver reliabilities are not excellent. This is a decisive drawback after all.
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References
Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: A systematic review. Arthroscopy 2015;31:2014-2020.
- Quality rating of MRI regarding TFCC lesions in the clinical practice.Handchir Mikrochir Plast Chir. 2012; 44 ([in German]): 310-313
- Instability of the distal radioulnar joint—An overview of clinical and radiological procedures regarding their efficacies.Handchir Mikrochir Plast Chir. 2014; 46 ([in German]): 137-150
- The effect of additional video documentation to photo documentation in wrist arthroscopies on intra- and interobserver reliability.Arch Orthop Trauma Surg. 2013; 133: 433-438
- Standard wrist arthroscopy: Technique and documentation.Oper Orthop Traumatol. 2014; 26: 539-546
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Note: The authors report that they have no conflicts of interest in the authorship and publication of this letter.
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© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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- Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic ReviewArthroscopyVol. 31Issue 10
- Author's ReplyArthroscopyVol. 31Issue 10
- PreviewIt was with great interest that I read the letter to the editor of Drs. Spies and Unglaub concerning our article “Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review.” I agree with their comments. The radiologic and clinical diagnostics of triangular fibrocartilage complex (TFCC) injury is challenging. The interpretation of the important peripheral attachment tears of the TFCC with magnetic resonance imaging (MRI) is even more difficult than central tears.
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