Triangular Fibrocartilage Complex (TFCC) – Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification

Abstract

Background

The TFCC consists of several components whose functional significance has been recognized in detail in recent years. Existing classifications are partly incomplete. In addition, the TFCC requires specific and dedicated imaging techniques.

Method

This review describes the anatomy and pathoanatomy of the TFCC. The different types of TFCC lesions on MRI as well as MR and CT arthrography are explained and compared with the current literature. In addition, the novel CUP classification is presented and illustrated with image examples.

Results and Conclusion

Anatomically and functionally, the articular disc and radioulnar ligaments with their ulnar insertions and the inhomogeneously structured TFCC periphery must be differentiated. For accurate imaging, thin slices with high in-plane resolution and techniques to optimize contrast are required. Plain MRI is exclusively dependent on T2 contrast, while gadolinium-enhanced MRI offers the additional benefit of focal contrast enhancement, e.g., of fibrovascular repair tissue at the lesion site. However, the reference standard continues to be MR and CT arthrography, which should be used for focused indications. The CUP classification, which allows a comprehensive description and categorization of TFCC lesions, is presented and illustrated.

Key Points

• Anatomically, the TFCC consists of the central ulnocarpal disc, the dorsal and palmar radioulnar ligaments, and the ulnocarpal joint capsule including intracapsular ligaments and the meniscus homologue.

• The most important restraining structure of the TFCC is the lamina fovealis, which stabilizes the DRUJ. This structure constitutes the proximal (deep) continuation of the radioulnar ligaments at the ulnar insertion.

• Imaging of the TFCC requires high spatial and contrast resolution due to its minute structures. MR and CT arthrography are the reference standard in imaging.

• The CUP classification clearly describes all structures of the TFCC with the categorization of individual or combined lesion patterns.

Citation Format

• Schmitt R, Kunz AS, Reidler P et al. Triangular Fibrocartilage Complex (TFCC) – Anatomy, Imaging, and Classifications with Special Focus on the CUP Classification. Fortschr Röntgenstr 2024; DOI 10.1055/a-2411-8444

Zusammenfassung

Hintergrund

Der TFCC besteht aus komplexen Einzelstrukturen, deren funktionelle Bedeutungen erst in den letzten Jahren im Detail erkannt wurden. Bestehende Klassifikationen sind zum Teil unvollständig. Zudem stellt der TFCC besondere Anforderungen an die Bildgebung.

Methode

In der Übersichtsarbeit werden die Anatomie und Pathoanatomie des TFCC beschrieben. Die verschiedenen Läsionsarten des TFCC werden in der MRT sowie der MR- und CT-Arthrografie erläutert und mit der aktuellen Literatur abgeglichen. Zudem wird die neuartige CUP-Klassifikation an Bildbeispielen vorgestellt.

Ergebnisse und Schlussfolgerung

Anatomisch und funktionell müssen am TFCC der Discus ulnocarpalis, die Ligg. radioulnaria mit ihren ulnaren Insertionen sowie die inhomogen aufgebaute Peripherie unterschieden werden. Zur sicheren Darstellung sind in der Bildgebung dünne Schichten mit hoher In-plane-Auflösung und Maßnahmen zur Kontrastoptimierung u.a. zur Differenzierung von Narbengewebe vonnöten. Dabei ist die native MRT ausschließlich vom T2-Kontrast abhängig, während die gadoliniumverstärkte MRT den Zusatznutzen einer fokalen Kontrastanreicherung am Läsionsort bietet. Referenzstandard sind jedoch weiterhin die MR- und CT-Arthrografie, die bei fokussierter Indikation angewendet werden sollten. Vorgestellt und illustriert wird die CUP-Klassifikation, die eine umfassende Beschreibung und Kategorisierung von TFCC-Läsionen ermöglicht.

Kernaussagen

• Anatomisch besteht der TFCC aus dem zentralen Discus ulnocarpalis, den dorsal und palmar umschließenden Ligg. radioulnaria und der ulnokarpalen Gelenkkapsel mit intrakapsulären Ligamenten und dem Meniscus homologue.

• Wichtigste Haltestruktur des TFCC ist die Lamina fovealis, die das DRUG stabilisiert. Sie ist die proximale (tiefe) Fortsetzung der Ligg. radioulnaria an deren ulnarer Insertion.

• Die Bildgebung erfordert am TFCC wegen dessen geringer Größe eine hohe Orts- und Kontrastauflösung. Die MR- und CT-Arthrografie sind der Referenzstandard in der Bildgebung.

• Die CUP-Klassifikation erlaubt die übersichtliche Darstellung aller Strukturen des TFCC mit Benennung einzelner oder kombinierter Schädigungsmuster.

Keywords

triangular fibrocartilage complex (TFCC) - articular disc - foveal lamina - styloid lamina - methods & techniques - MR-imaging - arthrography

Schlüsselwörter

ulnokarpaler Komplex (TFCC) - Discus ulnocarpalis - Lamina fovealis - Lamina styloidalis - Methoden & Technik - MRT - Arthrografie

Publikationsverlauf

Eingereicht: 30. Juni 2024

Angenommen nach Revision: 02. September 2024

Artikel online veröffentlicht:
01. Oktober 2024

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