Regarding “Biomechanical Comparison of Open and Arthroscopic Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears: A Cadaveric Study”

Abstract

It was with great interest that we read the article “Biomechanical Comparison of Open And Arthroscopic Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears: A Cadaveric Study” by Ma et al.1Ma C.H. Lin T.S. Wu C.H. Li D.Y. Yang S.C. Tu Y.K. Biomechanical comparison of open and arthroscopic transosseous repair of triangular fibrocartilage complex foveal tears: A cadaveric study.Arthroscopy. 2017; 33: 297-304Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Instability of the distal radioulnar joint is an extremely relevant pathology and, unfortunately, is often difficult to detect clinically. Therefore, it is important to conduct studies concerning the distal radioulnar joint. In this context we thank the authors for their contributions. Nevertheless, regarding the aforementioned study, a few issues ought to be highlighted. First, not only Ruch et al.2Ruch D.S. Anderson S.R. Ritter M.R. Biomechanical comparison of transosseous and capsular repair of peripheral triangular fibrocartilage tears.Arthroscopy. 2003; 19: 391-396Abstract Full Text Full Text PDF PubMed Scopus (35) Google Scholar have performed biomechanical studies of different triangular fibrocartilage complex (TFCC) repair techniques but Spies et al.3Spies C.K. Niehoff A. Unglaub F. et al.Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: A cadaver study.Int Orthop. 2016; 40: 315-321Crossref PubMed Scopus (12) Google Scholar have recently evaluated 2 different transosseous TFCC refixation procedures for the deep and superficial fibers. Second, no inclusion or exclusion criteria were defined for the specimens. Were radiographs obtained before testing to exclude osseous disorders? Third, the setup appears to be questionable. The removal of soft tissue is not clearly defined, and therefore standardization between the specimens may be at risk. Because the ulna is the “fixed” bone around which the radius rotates, fixation of the radius instead of the ulna may cause bias.3Spies C.K. Niehoff A. Unglaub F. et al.Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: A cadaver study.Int Orthop. 2016; 40: 315-321Crossref PubMed Scopus (12) Google Scholar Fourth, the approach to the ulnocarpal compartment and the detachment of the TFCC are not unequivocally described. Additional details may contribute to a better understanding. In our opinion, regarding the anatomy of the TFCC with the deep and superficial fibers, it would have been appropriate to add the Atzei classification for TFCC lesions.4Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability.J Hand Surg Eur. 2009; 34: 582-591Crossref Scopus (112) Google Scholar Fifth, how did the authors check the integrity of the TFCC before testing? Sixth, what was the rationale for the application of a 3-kg load to provoke displacement? Did the authors perform a pilot study? Seventh, the TFCC is a viscoelastic material. Why did the authors not evaluate the parameters of stiffness, creep, and hysteresis? They are key properties of viscoelastic materials to which connective tissue such as ligaments belongs. A material is viscoelastic when its mechanical behavior varies over time during application of a constant force or deformation.3Spies C.K. Niehoff A. Unglaub F. et al.Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: A cadaver study.Int Orthop. 2016; 40: 315-321Crossref PubMed Scopus (12) Google Scholar Biomechanical Comparison of Open and Arthroscopic Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears: A Cadaveric StudyArthroscopyVol. 33Issue 2PreviewTo biomechanically compare the stability between open repair and arthroscopic transosseous repair technique for reattachment of the foveal triangular fibrocartilage complex (TFCC). We also evaluated the feasibility of a new aiming device for the creation of 2 bone tunnels simultaneously during the arthroscopic technique. Full-Text PDF