Triangular fibrocartilage disorders: injury patterns and treatment.

On the basis of their arthroscopic experience with the diagnosis and management of acute and chronic lesions of the triangular fibrocartilage complex (TFCC), the authors review the anatomy and biomechanics of the TFCC, classify TFCC injury patterns, and suggest a treatment program for each pattern of injury. Traumatic patterns included central perforations (Class 1A), ulnar avulsions (Class 1B), distal avulsions (Class 1C), and radial avulsions (Class 1D). Degenerative (ulnar carpal abutment) patterns were classified (Class 2A-2E) by degree of severity and progressive involvement of adjacent structures. Arthroscopic debridement of the horizontal portion of the TFCC for Class 1A lesions and the Wafer procedure for Class 2C lesions have proved to be particularly successful over a 2-year follow-up, but the authors advise close long-term follow-up.