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CC BY 4.0 · J Wrist Surg 2024; 13(04): 302-309
DOI: 10.1055/s-0043-1771010
Scientific Article

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

Reinier Feitz 
1   Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
,
Yara E. van Kooij 
1   Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
4   Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
5   Xpert Clinics, Xpert Handtherapie, Flight Forum, Eindhoven, The Netherlands
,
Mark J. W. van der Oest 
1   Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
2   Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
,
J Sebastiaan Souer 
2   Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
,
Steven E. R. Hovius 
2   Hand and Wrist Center, Xpert Clinics, Amsterdam, The Netherlands
3   Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
,
Ruud W. Selles 
1   Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands
4   Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
,
the Hand–Wrist Study Group › Author Affiliations Funding No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this study.
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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).


Supplementary Material



Publication History

Received: 06 February 2023

Accepted: 07 June 2023

Article published online:
07 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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