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Is Midcarpal Arthroscopy for Suspected Scapholunate Pathology Associated With Greater Interobserver Agreement and More Frequent Offer of Surgery?

Published:August 28, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.07.001

      Purpose

      This study compared the interobserver agreement of arthroscopic classification of suspected scapholunate interosseous ligament (SLIL) pathology with and without midcarpal arthroscopy to help inform diagnostic strategies. It also measured the association of midcarpal arthroscopy with recommendations for reconstructive surgery. The association of midcarpal arthroscopy with the type of surgery recommended was also studied.

      Methods

      Fourteen consecutive videos of diagnostic radiocarpal and midcarpal wrist arthroscopy for suspected SLIL pathology were selected. An international survey-based experiment was conducted among upper extremity surgeons of the Science of Variation Group. Participants were randomized to view either radiocarpal arthroscopic videos or radiocarpal and midcarpal videos. Surgeons rated SLIL pathology according to the Geissler classification and recommended surgical or nonsurgical treatment. If surgical treatment was recommended, they indicated the type of procedure.

      Results

      The interobserver agreement for the Geissler classification was slight/fair for observers who reviewed midcarpal and radiocarpal videos and for those who viewed radiocarpal videos only. Viewing midcarpal videos was associated with higher pathology grades, the recommendation for reconstructive surgery, and a preference for tenodesis over scapholunate ligament repair.

      Conclusions

      Diagnostic wrist arthroscopy for a wrist with normal radiological alignment has poor interobserver agreement.

      Clinical relevance

      The pursuit of a pathology that accounts for wrist symptoms in a nonspecific interview and examination and normal radiographs is understandable; however, the low reliability of the scapholunate pathology of diagnostic arthroscopy might be associated with more potential harm than benefit.

      Key words

      JHS Podcast

      October 3, 2022

      Perspectives - October 2022

      Dr. Nicole Zelenski comments on the article "Is Midcarpal Arthroscopy for Suspected Scapholunate Pathology Associated With Greater Interobserver Agreement and More Frequent Offer of Surgery?", by Bakker et al, which is an Editor's Choice article in the October 2022 issue of the Journal of Hand Surgery.

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      References

        • Chung K.C.
        • Zimmerman N.B.
        • Travis M.T.
        Wrist arthrography versus arthroscopy: a comparative study of 150 cases.
        J Hand Surg Am. 1996; 21: 591-594
        • Mathoulin C.
        • Gras M.
        Role of wrist arthroscopy in scapholunate dissociation.
        Orthop Traumatol Surg Res. 2020; 106: S89-S99
        • Andersson J.K.
        Treatment of scapholunate ligament injury: current concepts.
        EFORT Open Rev. 2017; 2: 382-393
        • Kuo C.E.
        • Wolfe S.W.
        Scapholunate instability: current concepts in diagnosis and management.
        J Hand Surg Am. 2008; 33: 998-1013
        • Kitay A.
        • Wolfe S.W.
        Scapholunate instability: current concepts in diagnosis and management.
        J Hand Surg Am. 2012; 37: 2175-2196
        • Ruch D.S.
        • Bowling J.
        Arthroscopic assessment of carpal instability.
        Arthroscopy. 1998; 14: 675-681
        • Geissler W.B.
        Arthroscopic management of scapholunate instability.
        J Wrist Surg. 2013; 2: 129-135
        • Michelotti B.F.
        • Chung K.C.
        Diagnostic wrist arthroscopy.
        Hand Clin. 2017; 33: 571-583
        • Geissler W.B.
        • Freeland A.E.
        • Savoie F.H.
        • McIntyre L.W.
        • Whipple T.L.
        Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius.
        J Bone Joint Surg Am. 1996; 78: 357-365
        • Bakker D.
        • Kortlever J.T.P.
        • Kraan G.A.
        • et al.
        Treatment recommendations for suspected scapholunate ligament pathology.
        J Wrist Surg. 2021; 11: 62-68
        • Löw S.
        • Prommersberger K.J.
        • Pillukat T.
        • Van Schoonhoven J.
        Intra- and interobserver reliability of digitally photodocumented findings in wrist arthroscopy. Article in German.
        Handchir Mikrochir Plast Chir. 2010; 42: 287-292
        • Park A.
        • Lutsky K.
        • Matzon J.
        • Leinberry C.
        • Chapman T.
        • Beredjiklian P.K.
        An evaluation of the reliability of wrist arthroscopy in the assessment of tears of the triangular fibrocartilage complex.
        J Hand Surg Am. 2018; 43: 545-549
        • Chim H.
        • Moran S.L.
        Wrist essentials: the diagnosis and management of scapholunate ligament injuries.
        Plast Reconstr Surg. 2014; 134: 312e-322e
        • Hofmeister E.P.
        • Dao K.D.
        • Glowacki K.A.
        • Shin A.Y.
        The role of midcarpal arthroscopy in the diagnosis of disorders of the wrist.
        J Hand Surg Am. 2001; 26: 407-414
        • Verrilli D.
        • Welch H.G.
        The impact of diagnostic testing on therapeutic interventions.
        JAMA. 1996; 275: 1189-1191
        • Black W.C.
        • Welch H.G.
        Screening for disease.
        AJR Am J Roentgenol. 1997; 168: 3-11
        • Bruinsma W.E.
        • Guitton T.G.
        • Warner J.J.P.
        • Ring D.
        • Science of Variation Group
        Interobserver reliability of classification and characterization of proximal humeral fractures: a comparison of two and three-dimensional CT.
        J Bone Joint Surg Am. 2013; 95: 1600-1604
        • Guitton T.G.
        • Ring D.
        • Science of Variation Group
        Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT.
        J Bone Joint Surg Am. 2011; 93: 2015-2021
        • Harness N.G.
        • Ring D.
        • Zurakowski D.
        • Harris G.J.
        • Jupiter J.B.
        The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures.
        J Bone Joint Surg Am. 2006; 88: 1315-1323
        • Welch H.G.
        • Kramer B.S.
        • Black W.C.
        Epidemiologic signatures in cancer.
        N Engl J Med. 2019; 381: 1378-1386
        • Wolfe S.W.
        • Gupta A.
        • Crisco III, J.J.
        Kinematics of the scaphoid shift test.
        J Hand Surg Am. 1997; 22: 801-806
        • Pirela-Cruz M.A.
        • Hilton M.E.
        • Faillace J.
        Frequency and characteristics of the scaphoid cortical ring sign.
        Surg Radiol Anat. 2003; 25: 451-454
        • Wijffels M.M.E.
        • Guitton T.G.
        • Ring D.
        • Science of Variation Group
        Inter-observer variation in the diagnosis of coronal articular fracture lines in the lunate facet of the distal radius.
        Hand (N Y). 2012; 7: 271-275
        • Beks R.B.
        • Drijkoningen T.
        • Claessen F.
        • Guitton T.G.
        • Ring D.
        • Science of Variation Group
        Interobserver variability of the diagnosis of scaphoid proximal pole fractures.
        J Wrist Surg. 2018; 7: 350-354
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Andersson J.K.
        • Andernord D.
        • Karlsson J.
        • Fridén J.
        Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: a systematic review.
        Arthroscopy. 2015; 31: 2014-2020.e2
        • Walsh J.J.
        • Berger R.A.
        • Cooney W.P.
        Current status of scapholunate interosseous ligament injuries.
        J Am Acad Orthop Surg. 2002; 10: 32-42
        • O’Meeghan C.J.
        • Stuart W.
        • Mamo V.
        • Stanley J.K.
        • Trail I.A.
        The natural history of an untreated isolated scapholunate interosseus ligament injury.
        J Hand Surg Br. 2003; 28: 307-310
        • Dornberger J.E.
        • Rademacher G.
        • Mutze S.
        • Eisenschenk A.
        • Stengel D.
        Accuracy of simple plain radiographic signs and measures to diagnose acute scapholunate ligament injuries of the wrist.
        Eur Radiol. 2015; 25: 3488-3498
        • Dornberger J.E.
        • Rademacher G.
        • Stengel D.
        • et al.
        What is the diagnostic accuracy of flat-panel cone-beam ct arthrography for diagnosis of scapholunate ligament tears?.
        Clin Orthop Relat Res. 2021; 479: 151-160
        • Kassirer J.P.
        Our stubborn quest for diagnostic certainty. A cause of excessive testing.
        N Engl J Med. 1989; 320: 1489-1491
        • Papakonstantinou M.K.
        • Hart M.J.
        • Farrugia R.
        • et al.
        Interobserver agreement of Neer and AO classifications for proximal humeral fractures.
        ANZ J Surg. 2016; 86: 280-284
        • Mellema J.J.
        • Kuntz M.T.
        • Guitton T.G.
        • Ring D.
        The effect of two factors on interobserver reliability for proximal humeral fractures.
        J Am Acad Orthop Surg. 2017; 25: 69-76
        • Manning D.
        Samei E. Krupinski E. The Handbook of Medical Image Perception and Techniques. Cambridge University Press, 2018
        • Crijns T.J.
        • Janssen S.J.
        • Davis J.T.
        • Ring D.
        • Sanchez H.B.
        • Science of Variation Group
        Reliability of the classification of proximal femur fractures: does clinical experience matter?.
        Injury. 2018; 49: 819-823
        • Crijns T.J.
        • Mellema J.J.
        • Özkan S.
        • Ring D.
        • Chen N.C.
        • Science of Variation Group
        Classification of tibial plateau fractures using 3DCT with and without subtraction of unfractured bones.
        Injury. 2020; 51: 2686-2691
        • Mohamadi A.
        • Claessen F.M.A.P.
        • Ozkan S.
        • Kolovich G.P.
        • Ring D.
        • Chen N.C.
        Diagnostic wrist arthroscopy for nonspecific wrist pain.
        Hand (N Y). 2017; 12: 193-196
        • Colloca L.
        • Barsky A.J.
        Placebo and nocebo effects.
        N Engl J Med. 2020; 382: 554-561
        • Kaptchuk T.J.
        • Miller F.G.
        Placebo effects in medicine.
        N Engl J Med. 2015; 373: 8-9
        • Crijns T.J.
        • Brinkman N.
        • Ramtin S.
        • et al.
        Are there distinct statistical groupings of mental health factors and pathophysiology severity among people with hip and knee osteoarthritis presenting for specialty care?.
        Clin Orthop Relat Res. 2022; 480: 298-309
        • Miner H.
        • Rijk L.
        • Thomas J.
        • Ring D.
        • Reichel L.M.
        • Fatehi A.
        Mental-health phenotypes and patient-reported outcomes in upper-extremity illness.
        J Bone Joint Surg Am. 2021; 103: 1411-1416