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
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Article info
Publication history
Published online: August 28, 2022
Accepted:
July 6,
2022
Received:
August 30,
2021
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
