Patient-Rated Wrist Evaluation Threshold for Successful Open Surgery of the Triangular Fibrocartilage Complex

Abstract

Purpose To determine thresholds in patient-reported outcome measures at baseline in patients electing to undergo triangular fibrocartilage complex (TFCC) surgery to select patients with clinically improved outcomes.

Methods The study cohort comprised consecutive patients who underwent open TFCC repair between December 2011 and December 2018 in various clinics in the Netherlands. All patients were asked to complete the patient-rated wrist evaluation (PRWE) questionnaire at baseline as well as at 12 months postoperatively. The minimal clinically important difference (MCID) for the PRWE was calculated to be 24 using an anchor-based method. We compared patient, disease, and surgical characteristics between patients who did and did not reach the MCID. The t-tests and chi-square tests were undertaken to test differences between outcomes and satisfaction in patients who did or did not reach the MCID.

Results Patients (34%) who did not reach MCID had a longer history of complaints. The chances of reaching the MCID for patients with a low PRWE score at baseline were slim. Of patients with a PRWE score <34 at baseline, only 14% reached the MCID, whereas in patients with a PRWE score of ≥34, 69% reached the MCID.

Conclusion A PRWE total score at baseline <34 is a strong signal to reconsider open surgery of the TFCC because the chance of reaching a clinically meaningful outcome is slim.

Level of Evidence II.

Type of Study Therapeutic.

Keywords

TFCC - triangular fibrocartilage - PROM - surgery - open reinsertion - outcome - prognostic factors

Type of Study

LEVEL II, prognostic study, high-quality prospective study <80% follow-up, consecutive patients.

Ethical Approval of the Study Protocol

The ethics committee of the Erasmus University Medical Center approved our study protocol (NL/sl/MEC-2018-1088). All patients provided consent for their data to be used in this study.

Authors' Contribution

R.F., Y.E.v.K. and M.J.W.O. did the analyses. R.F., J.S.S., and S.E.R.H. treated several patients. All authors contributed to the design of the study, discussed the results, commented on the manuscript, and reviewed the final version. Each of the HWS group collaborators contributed by treating patients from the cohort or engaging in defining, enabling, or managing the data collection/analyses.

^* See Appendix A (available in the online version).

Publikationsverlauf

Eingereicht: 06. Februar 2023

Angenommen: 07. Juni 2023

Artikel online veröffentlicht:
07. Juli 2023

• References

• 1 Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018; 5 (01) 6
• 2 Luchetti R, Atzei A, Cozzolino R, Fairplay T, Badur N. Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability. J Hand Surg Eur Vol 2014; 39 (08) 845-855
• 3 Feitz R, Teunissen JS, van der Oest MJW, van der Heijden EPA, Selles RW, Hovius SER. Hand–Wrist Study Group. Factors associated with return to work after open reinsertion of the triangular fibrocartilage. Hand Surg Rehabil 2021; 40 (04) 405-412
• 4 Feitz R, van der Oest MJW, van der Heijden EPA, Slijper HP, Selles RW, Hovius SER. Hand-Wrist Study Group. Patient-reported outcomes and function after reinsertion of the triangular fibrocartilage complex by open surgery. Bone Joint J 2021; 103-B [phone]
• 5 Blackburn J, van der Oest MJW, Selles RW. et al. Which psychological variables are associated with pain and function before surgery for de Quervain's tenosynovitis? A cross-sectional study. Clin Orthop Relat Res 2019; 477 (12) 2750-2758
• 6 Tsehaie J, van der Oest MJW, Poelstra R. et al; Hand-Wrist Study Group. Positive experience with treatment is associated with better surgical outcome in trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2019; 44 (07) 714-721
• 7 van der Oest MJW, Poelstra R, Feitz R. et al; Hand-Wrist Study Group. Illness perceptions of patients with first carpometacarpal osteoarthritis, carpal tunnel syndrome, Dupuytren contracture, or trigger finger. J Hand Surg Am 2020; 45 (05) 455.e1-455.e8
• 8 Selles RW, Wouters RM, Poelstra R. et al; Hand-Wrist Study Group. Routine health outcome measurement: development, design, and implementation of the hand and wrist cohort. Plast Reconstr Surg 2020; 146 (02) 343-354
• 9 Feitz R, van Kooij YE, Ter Stege MHP. et al; Hand–Wrist Study Group. Closing the loop: a 10-year experience with routine outcome measurements to improve treatment in hand surgery. EFORT Open Rev 2021; 6 (06) 439-450
• 10 Garcia-Elias M, Smith DE, Llusá M. Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 2003; 7 (04) 134-140
• 11 Jung H-S, Park MJ, Won Y-S, Lee GY, Kim S, Lee JS. The correlation between shape of the sigmoid notch of the distal radius and the risk of triangular fibrocartilage complex foveal tear. Bone Joint J 2020; 102-B [phone]
• 12 Videler AJ, Schreuders TAR. De Nederlandse versie van de Patient Rated Wrist/Hand Evaluation: de PRWHE-DLV. Accessed October 6, 2021, at: https://meetinstrumentenzorg.nl/instrumenten/patient-rated-wrist-hand-evaluation-patient-rated-wrist-evaluation/
• 13 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
• 14 Sorensen AA, Howard D, Tan WH, Ketchersid J, Calfee RP. Minimal clinically important differences of 3 patient-rated outcomes instruments. J Hand Surg Am 2013; 38 (04) 641-649
• 15 Terluin B, Eekhout I, Terwee CB, de Vet HC. Minimal important change (MIC) based on a predictive modeling approach was more precise than MIC based on ROC analysis. J Clin Epidemiol 2015; 68 (12) 1388-1396
• 16 Terluin B, Eekhout I, Terwee CB. The anchor-based minimal important change, based on receiver operating characteristic analysis or predictive modeling, may need to be adjusted for the proportion of improved patients. J Clin Epidemiol 2017; 83: 90-100
• 17 Hosmer Jr DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression. Vol. 398. John Wiley & Sons: Hoboken, New Jersey, USA; 2013
• 18 Hoogendam L, Koopman JE, van Kooij YE. et al; Hand-Wrist Study Group. What are the minimally important changes of four commonly used patient-reported outcome measures for 36 hand and wrist condition-treatment combinations?. Clin Orthop Relat Res 2022; 480 (06) 1152-1166
• 19 Poelstra R, Selles RW, Slijper HP. et al; Hand-Wrist Study Group. Better patients' treatment experiences are associated with better postoperative results in Dupuytren's disease. J Hand Surg Eur Vol 2018; 43 (08) 848-854
• 20 Yeo MGH, Goh GS, Chen JY, Lo NN, Yeo SJ, Liow MHL. Are Oxford hip score and Western Ontario and McMaster Universities Osteoarthritis Index useful predictors of clinical meaningful improvement and satisfaction after total hip arthroplasty?. J Arthroplasty 2020; 35 (09) 2458-2464
• 21 Berliner JL, Brodke DJ, Chan V, SooHoo NF, Bozic KJ. Can preoperative patient-reported outcome measures be used to predict meaningful improvement in function after TKA?. Clin Orthop Relat Res 2017; 475 (01) 149-157
• 22 Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open versus arthroscopic repair of 1B ulnar-sided triangular fibrocartilage complex tears: a systematic review. Hand (N Y) 2020; 15 (04) 456-464
• 23 Robba VI, Karantana A, Fowler APG, Diver C. Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study. J Hand Surg Eur Vol 2019; 44 (06) 572-581
• 24 Stratford P, Gill C, Westaway M, Binkley J. Assessing disability and change on individual patients: a report of a patient specific measure. Physiother Can 1995; 47 (04) 258-263
• 25 Tubach F, Ravaud P, Baron G. et al. Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 2005; 64 (01) 29-33
• 26 Tubach F, Ravaud P, Martin-Mola E. et al. Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: results from a prospective multinational study. Arthritis Care Res (Hoboken) 2012; 64 (11) 1699-1707
• 27 Marks M, Hensler S, Wehrli M, Schindele S, Herren DB. Minimal important change and patient acceptable symptom state for patients after proximal interphalangeal joint arthroplasty. J Hand Surg Eur Vol 2019; 44 (02) 175-180
• 28 Wilson CD, Mand D, Ring D, Ramtin S. A systematic review of satisfaction measures in hand and wrist surgery. J Hand Surg Am 2023; 48 (01) 1-8