Interobserver Reliability of the Trampoline Test, Hook Test, and Suction Test in Arthroscopic Assessment of Triangular Fibrocartilage Complex Lesions.

Abstract

The aim of this study was to evaluate the interobserver reliability of 3 commonly used arthroscopic diagnostic signs for assessing triangular fibrocartilage complex (TFCC) lesions: the trampoline test, the hook test, and the suction test. This retrospective observational study included 26 consecutive patients who underwent wrist arthroscopy for suspected TFCC or intercarpal ligament injury. Five patients with intraoperative TFCC disc perforation were excluded, leaving 21 arthroscopy videos for analysis. All procedures were performed using standard wrist arthroscopy portals. A senior wrist surgeon established the reference diagnosis based on clinical examination, preoperative arthrocomputed tomography, and arthroscopic findings. The anonymized videos were independently reviewed by 3 board-certified hand surgeons with experience in wrist arthroscopy, all blinded to clinical and operative data. Reviewers assessed the presence or absence of loss of the trampoline sign, a positive hook test, and the suction test. Interobserver reliability was evaluated using Cohen's kappa coefficient. All arthroscopy videos were considered to be of adequate diagnostic quality. The hook test demonstrated excellent interobserver agreement among reviewers, whereas the trampoline and suction tests showed only moderate reproducibility. Arthroscopic diagnostic signs for TFCC lesions do not demonstrate equivalent reliability. The hook test appears to be the most reproducible and reliable indicator of TFCC incompetence, particularly in foveal tears. In contrast, the trampoline and suction tests showed greater variability between observers.