JHS - 2026-08-24 - Journal Article
Inter- and Intraobserver Reliability of Wrist Arthroscopy for TFCC Tears: An International Study.
Räisänen MP, Smeraglia F, Clementson M, Gvozdenovic R, Kask K, Goldfarb CA
Topics
Key Takeaway
Among 5 experienced hand surgeons reviewing 43 wrist arthroscopy cases, interobserver agreement for TFCC tear presence was only fair (Fleiss' kappa not specified numerically), classification agreement was slight-to-fair, and treatment decision agreement was low, with central tears showing higher presence/absence agreement (94.3%) than peripheral tears (80.0–85.0%).
Summary Depth
Choose how much analysis to show on this article page.
Summary
Five experienced European hand surgeons independently reviewed 43 standardized wrist arthroscopy cases (video, radiographs, clinical vignette) at two time points 6 weeks apart, with a consensus meeting between rounds, rating TFCC tear presence, Palmer and Atzei-Luchetti classification, and treatment decisions. Interobserver agreement for tear presence was fair in both rounds with minimal improvement after consensus; classification agreement was slight-to-fair and treatment agreement was low. Central tears showed higher presence/absence agreement (94.3% both rounds) versus peripheral tears (80.0–85.0%), while Palmer classification agreement was paradoxically higher for peripheral tears in Round 2 (61.3% vs. 38.6% central).
Key Limitation
Five surgeons from a single European network is too small a panel to generate stable kappa estimates and may reflect a regionally homogeneous training background, underestimating true international variability.
Original Abstract
PURPOSE
To evaluate the interobserver and intraobserver reliability of wrist arthroscopy for the diagnosis and classification of triangular fibrocartilage complex (TFCC) tears among experienced European hand surgeons, to assess the effect of a consensus meeting on reliability, and to determine whether reliability differs between different tears.
METHODS
Five hand surgeons from Europe reviewed 43 standardized wrist arthroscopy cases at two time points separated by 6 weeks. Each case included a clinical vignette, radiographs, and arthroscopy video. Surgeons assessed for the presence of a TFCC tear, classified tears using the Palmer and Atzei-Luchetti systems, and recorded treatment decisions. A consensus meeting was held between rounds. For the whole cohort, interobserver reliability was assessed using Fleiss' kappa and intraobserver reliability using Cohen's kappa. For subgroup analyses, interobserver reliability was assessed using pairwise agreement.
RESULTS
Interobserver agreement for TFCC tear presence was fair in both rounds, with modest improvement after the consensus meeting. Agreement for TFCC classification was slight-to-fair, and agreement for treatment decisions was low. Intraobserver agreement was consistently higher than interobserver agreement and generally moderate. Subgroup analyses showed higher interobserver agreement for central tears than peripheral tears in assessing TFCC tear presence/absence (central: 94.3% in both rounds versus peripheral: 80.0% and 85.0%). In contrast, for Palmer classification, agreement was higher for peripheral tears, particularly in Round 2 (peripheral: 61.3% versus central: 38.6%). Similar patterns were observed when combined tears were included. The consensus meeting did not meaningfully increase agreement within subgroups between rounds.
CONCLUSIONS
Arthroscopy demonstrated only moderate reliability for the assessment of TFCC pathology in this study, even among experienced hand surgeons. Although tear presence is commonly recognized, substantial variability persists in classification and decision making for treatment.
CLINICAL RELEVANCE
These findings highlight limitations of current arthroscopic classification systems and underscore the need for improved education and classification optimization to enhance diagnostic reproducibility.