To the editor,
We read the study by Yamanaka and colleagues [6] with great interest. The authors of the study examined the thickness and suspension of the triangular fibrocartilage (TFC) of patients after ulnar shortening using MRI to evaluate potential regeneration of the articular disc. This study shows reparation of the TFC after ulnar shortening using MRI for the first time. These results represent an important contribution to the issue of regenerative potential of the articular disc. In this context, we would like to ask a few questions concerning this publication.
The authors diagnosed the triangular fibrocartilage complex (TFCC) lesions based on clinical signs, and partly on wrist arthrography performed before surgery. Arthroscopy was combined with the index operation (ulnar shortening) in a single-staged procedure. Why were no arthroscopic procedures performed at an earlier stage in order to evaluate TFCC lesions objectively since this method is still the gold standard regarding this structure [2]?
Second, the authors detected a change of TFC angle after ulnar shortening, which they attributed to the degree of distal radioulnar joint (DRUJ) stability. We wondered whether an increased postoperative DRUJ stability could be verified clinically [1, 5]. Additionally, could the authors find a correlation between the type of articular disc lesion to disc thickness after ulnar shortening? We would expect greater thickness, and respective higher regenerative potential for Palmer Type 2A/2B lesions versus Palmer Type 2D/2E after ulnar shortening since late-stage lesions (2D/2E) are characterised by a higher amount of apoptotic cells.
Finally, we wondered whether a change in disc thickness might contribute to cell regeneration, or whether this change could be caused by accumulation of bound-water molecules within the extracellular matrix [3] after load reduction following ulnar shortening [4]?
Footnotes
(RE: Yamanaka Y, Nakamura T, Sato K, Toyama Y. How Does Ulnar Shortening Osteotomy Influence Morphologic Changes in the Triangular Fibrocartilage Complex? [Published online ahead of print August 13, 2014]. Clin Orthop Relat Res. DOI: 10.1007/s11999-014-3854-9.)
The authors certify that they, or any member of their immediate families, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®.
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