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Introduction: Wrist MRI has established utility in the diagnosis of wrist ligament tears, including complete tears of the ulnotriquetral ligament (UTL) and other components of the triangular fibrocartilage complex (TFCC). A new type of longitudinal split tear of the UTL has recently been described without any imaging correlate. Our aim was to describe putative primary and secondary MRI findings associated with UTL split tears and assess diagnostic accuracy.

Materials & Methods: 40 patients with arthroscopically proven UTL split tears and 20 patients with intact UTLs, all of whom had preoperative 3T MRI of the same wrist performed, were randomly selected from a list of operative notes spanning 1/1/1997 – 10/31/2011, filtered with the terms “ulnotriquetral ligament” and “ulnar triquetral ligament.” Two musculoskeletal radiologists independently reviewed the exams, blinded to surgical results and clinical information. The readers recorded degree of certainty of abnormality with UTL, whether a UTL split tear was present, and whether several potential secondary signs were present.

Results: Overall sensitivity for definitive UTL split tear detection on MRI was 57.5% (42.2-71.5%) for reader 1 and 30.0% (18.1-45.4%) for reader 2. Specificity was 60.0% (38.7-78.1%) for both. There were no statistically significant discriminatory secondary findings.

Conclusions: Among a selected group of patients who all had wrist arthroscopy, preoperative non-contrast 3T wrist MRI has poor sensitivity and specificity for detection of the longitudinal split type of UTL tear. Presently MRI may be more helpful to exclude potential alternative diagnoses in the patient with ulnar wrist pain.