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Degeneration of the articular disc in the human triangular fibrocartilage complex

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Abstract

Introduction

Traumatic injuries of the triangular fibrocartilage complex (TFCC) are frequent reasons for ulnar wrist pain. The assessment of the extent of articular disc (AD) degeneration is important for the differentiation of acute injuries versus chronic lesions.

Materials and methods

The AD of the TFCC of eleven human cadaver wrists was dissected. Degeneration was analyzed according to the grading of Krenn et al. Hematoxylin–eosin was used to determine the tissue morphology. Degeneration was evaluated using the staining intensity of alcian blue, the immunohistochemistry of the proteoglycan versican and the immunoreactivity of NITEGE, an aggrecan fragment.

Results

The staining homogeneity of HE decreased with higher degeneration of the AD and basophilic tissue areas were more frequently seen. Two specimens were characterized as degeneration grade 1, five specimens as grade 2, and four specimens as grade 3, respectively. Staining intensity of alcian blue increased with higher degeneration grade of the specimens. Immunoreactivity for NITEGE was detected around tissue fissures and perforations as well as matrix splits. Immunoreactivity for versican was found concentrated in the tissue around matrix fissures and lesions as well as loose connective tissue at the ulnar border of the AD. Specimens with degeneration grade 2 had the strongest immunoreactivity of NITEGE and versican. Cell clusters were observed in specimens with degeneration grade 2 and 3, which were stained by alcian blue and immunoreactive for NITEGE and versican. Increasing age of the cadaver wrists correlated with a higher degree of degeneration (p < 0.0001, r = 0.68).

Conclusions

The fibrocartilage of degenerated ADs contains NITEGE and versican. The amount of the immunoreactivity of these markers allows the differentiation of degenerative changes into three grades. The degeneration of the AD increases with age and emphasizes its important mechanical function.

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Abbreviations

AD:

Articular disc

HE:

Hematoxylin-eosin

NITEGE:

Hexapeptide of the amino acids: asparagine (N), isoleucine (I), threonine (T), glutamic acid (E), glycine (G) and glutamic acid (E); G1 fragment of the proteoglycan aggrecan

OA:

Osteoarthritis

PBS:

Phosphate buffer saline

TFCC:

Triangular fibrocartilage complex

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Acknowledgements

The authors thank the following colleagues for their support: Suzanne Manthey, Dorothea Liebeheim, Thomas Albrecht, Florian Hesse, Manuel Llusá Pérez, MD, PhD and Hans Zwipp, MD, PhD.

Funding

This study was financially supported by the Center for Sports Research (CIF), Stockholm, Sweden through the contribution of funds for the purchase of immunohistochemical markers (funding number: CIF Dnr 1024/11).

Author information

Authors and Affiliations

  1. Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, Leipzig, Germany

    Susanne Rein & Thomas Kremer

  2. Martin-Luther-University of Halle-Wittenberg, Halle, Germany

    Susanne Rein

  3. Medizinisches Versorgungszentrum für Histologie, Zytologie und Molekulare Diagnostik Trier, Max-Planck-Str. 5, Düren, Düsseldorf, 54296, Trier, Germany

    Veit Krenn

  4. Arcademy, H.M Queen Sophia Hospital, Stockholm, Sweden

    Elisabet Hagert

  5. Department of Clinical Science and Education, Karolinska Institutet, Sjukhusbacken 10, 118 83, Stockholm, Sweden

    Elisabet Hagert

  6. Musculoskeletal and Sports Injury Epidemiology Center, Department of Health Promotion Science, Sophiahemmet University, Stockholm, Sweden

    Elisabet Hagert

  7. Institut Kaplan Hand and Upper Extremity Surgery, Avenida Josep Vicenç Foix 71, 08034, Barcelona, Spain

    Marc Garcia-Elias & Alex Lluch

  8. Departamento de Anatomía, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain

    Marc Garcia-Elias & Alex Lluch

  9. Sächsischen Krankenhaus Altscherbitz, Department of Neurology, Leipziger Straße 59, 04435, Schkeuditz, Germany

    Manuel Semisch

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Contributions

All authors made substantive intellectual contributions to this study, in conception and design (SR, VK EH, MGE, AL, MS), acquisition of data (SR, EH, MGE, AL), analysis and interpretation of data (SR, VK EH, MGE, AL, MS), drafting and revising the manuscript (SR, VK EH, MGE, AL, TK, MS), as well as final approval of the version to be submitted (SR, VK EH, MGE, AL, TK, MS).

Corresponding author

Correspondence to Susanne Rein.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. All authors disclose any financial and personal relationships with other people or organizations that could potentially and inappropriately influence this study and conclusions. All authors declared no potential conflicts of interest with respect to the research, authorship, and/ or publication of this article.

Ethical approval

The local ethical committee of the Medical Faculty of the Technical University Dresden approved this study under the processing number: EK 300082013.

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Rein, S., Krenn, V., Hagert, E. et al. Degeneration of the articular disc in the human triangular fibrocartilage complex. Arch Orthop Trauma Surg 141, 699–708 (2021). https://doi.org/10.1007/s00402-021-03795-2

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