Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint

Abstract

Objective Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. Materials & Methods We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). Results and conclusion Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p<0.01). The diagnostic value of the C-T distance was sufficient for women with type I (AUROC=0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool for assessing full-thickness LTIL tears.

Dynamic MRI of the wrist in less than 20 seconds: normal midcarpal motion and reader reliability

“…We found the CTD to be wider in wrists with type II lunates, which is consistent with prior research [15,35]. We also observed that the CTD was wider in male wrists in the neutral position only, which is also in line with prior research [15].…”

“…Type II lunate morphology and wider CTD also have been associated with decreased DISI deformity and more proximally located fractures in patients presenting with scaphoid nonunion [35]. Finally, an increased CTD has been associated with ulnar impaction syndrome [37] and full-thickness lunotriquetral ligament tears [15].…”

“…Similarly, CTD was evaluated on images with the wrist in neutral, in maximum radial deviation, and in maximum ulnar deviation. As described by previous investigators [15], the CTD was measured from the radial aspect of the triquetrum to the ulnar aspect of the capitate. For determination of row versus column kinematic patterns on MRI, we modified the methods described by Garcia-Elias et al [27] that evaluated scaphoid flexion during radial and ulnar deviation on frontal radiographs.…”

“…With respect to anatomic factors, lunate morphology may play an important role in influencing midcarpal motion patterns [12,13] (Table 1). Specifically, in lunates with a facet that articulates with the hamate, referred to as type II lunates [14], there is an association with a wider capitate-to-triquetrum distance (CTD) in the midcarpal compartment and with full-thickness perforation of the lunotriquetral ligament in patients with pain assessed by MR arthrography [15] and arthroscopy [16].…”

A principal component analysis-based framework for statistical modeling of bone displacement during wrist maneuvers

“…The ability of the basis functions to summarize wrist displacement comprehensively will help improve our understanding of the physiologically normal displacement of wrist tissues and for defining basis functions specifically for diagnosing, staging, quantifying, and longitudinally track wrist motion dysfunction. Several prospective applications of such knowledge could be considered, such as characterizing dynamic wrist instability (wrist bone malalignment during motion) (Garcia-Elias et al, 2014;Kuo & Wolfe, 2008;Lee et al, 2011), differences in symptomatic and asymptomatic participants with anatomical differences or variations, such as hyperlaxity or type 2 lunates (Abe et al, 2017;Borgese et al, 2017), and the outcomes of orthopaedic fusion, repair or reconstructive procedures (Walsh et al, 2002).…”