Advertisement

Is Early Active Motion After 3-Ligament Tenodesis Noninferior to Late Active Motion? A Prospective, Multicenter Cohort Study

Published:August 30, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.07.002

      Purpose

      If early active motion after 3-ligament tenodesis is safe, it may yield more patient comfort and an early return to activities. Therefore, the aim of this study was to investigate whether early active motion is noninferior to late active motion after 3-ligament tenodesis for scapholunate interosseous ligament injuries.

      Methods

      This prospective, multicenter cohort study, using a noninferiority design with propensity score matching, compared a late active motion protocol (immobilization for 10–16 days, wrist therapy in weeks 5–6) with an early active motion protocol (immobilization for 3–5 days, wrist therapy during week 2). Patients who were older than 18 years, had complete baseline information on demographics, and underwent 3-ligament tenodesis were included. The outcome measures were postoperative Patient-Reported Wrist/Hand Evaluation scores, pain, complications, return to work, range of motion, grip strength, and satisfaction with treatment results at 3 months of follow-up.

      Results

      After propensity matching, a total of 108 patients were included. Patient-Reported Wrist/Hand Evaluation and pain scores during physical load following an early active motion protocol were noninferior compared with scores following a late active motion protocol. Furthermore, early active motion did not lead to an increase of complications, differences in range of motion or grip strength, or less satisfaction with the treatment result. An earlier return to work was not observed.

      Conclusions

      Early active motion leads to noninferior results without more complications as compared with late active motion. Based on these findings, early active motion can be considered safe, and might be recommended due to its potential benefits compared with late active motion after 3-ligament tenodesis.

      Type of study/level of evidence

      Therapeutic III.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mayfield J.K.
        Mechanism of carpal injuries.
        Clin Orthop Relat Res. 1980; 149: 45-54
        • Gelberman R.H.
        • Cooney III, W.P.
        • Szabo R.M.
        Carpal instability.
        Instr Course Lect. 2001; 50: 123-134
        • Watson H.K.
        • Ballet F.L.
        The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis.
        J Hand Surg Am. 1984; 9: 358-365
        • Brunelli G.A.
        • Brunelli G.R.
        A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report.
        J Hand Surg Am. 1995; 20: S82-S85
        • Garcia-Elias M.
        • Lluch A.L.
        • Stanley J.K.
        Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique.
        J Hand Surg Am. 2006; 31: 125-134
        • Rosati M.
        • Parchi P.
        • Cacianti M.
        • Poggetti A.
        • Lisanti M.
        Treatment of acute scapholunate ligament injuries with bone anchor.
        Musculoskelet Surg. 2010; 94: 25-32
        • Van Den Abbeele K.L.S.
        • Loh Y.C.
        • Stanley J.K.
        • Trail I.A.
        Early results of a modified brunelli procedure for scapholunate instability.
        J Hand Surg Br. 1998; 23: 258-261
        • Chabas J.F.
        • Gay A.
        • Valenti D.
        • Guinard D.
        • Legre R.
        Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients.
        J Hand Surg Am. 2008; 33: 1469-1477
        • Elgammal A.
        • Lukas B.
        Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients.
        J Hand Surg Eur Vol. 2016; 41: 56-63
        • Blackburn J.
        • van der Oest M.J.W.
        • Poelstra R.
        • et al.
        Three-ligament tenodesis for chronic scapholunate injuries: short-term outcomes in 203 patients.
        J Hand Surg Eur Vol. 2020; 45: 383-388
        • Pauchard N.
        • Dederichs A.
        • Segret J.
        • Barbary S.
        • Dap F.
        • Dautel G.
        The role of three-ligament tenodesis in the treatment of chronic scapholunate instability.
        J Hand Surg Eur Vol. 2013; 38: 758-766
        • Athlani L.
        • Pauchard N.
        • Dap F.
        • Dautel G.
        Treatment of chronic scapholunate instability: results with three-ligament tenodesis vs. scapholunate and intercarpal ligamentoplasty.
        Hand Surg Rehabil. 2019; 38: 157-164
        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • Bakker D.
        • Kraan G.A.
        • Mathijssen N.M.C.
        • Colaris J.W.
        • Kleinrensink G.J.
        Assessment of flexion elongation relation and type of failure after capsulodesis.
        J Wrist Surg. 2020; 9: 382-387
        • MacDermid J.C.
        Development of a scale for patient rating of wrist pain and disability.
        J Hand Ther. 1996; 9: 178-183
        • Veehof M.M.
        • Sleegers E.J.A.
        • Van Veldhoven N.H.M.J.
        • Schuurman A.H.
        • Van Meeteren N.L.U.
        Psychometric qualities of the Dutch language version of the disabilities of the arm, shoulder, and hand questionnaire (DASH-DLV).
        J Hand Ther. 2002; 15: 347-354
        • American Society for Hand Therapists
        Clinical Assessment Recommendations.
        2nd ed. American Society for Hand Therapists, 1992
        • Mathiowetz V.
        • Kashman N.
        • Volland G.
        • Weber K.
        • Dowe M.
        • Rogers S.
        Grip and pinch strength: normative data for adults.
        Arch Phys Med Rehabil. 1985; 66: 69-74
        • Clavien P.A.
        • Sanabria J.R.
        • Strasberg S.M.
        Proposed classification of complications of surgery with examples of utility in cholecystectomy.
        Surgery. 1992; 111: 518-526
        • Wouters R.M.
        • Jobi-Odeneye A.O.
        • de la Torre A.
        • et al.
        A standard set for outcome measurement in patients with hand and wrist conditions: consensus by the International Consortium for Health Outcomes Measurement Hand and Wrist Working Group.
        J Hand Surg Am. 2021; 46: 841-855.e7
        • De Ridder W.A.
        • van Kooij Y.E.
        • Vermeulen G.M.
        • et al.
        Test-retest reliability and construct validity of the Satisfaction with Treatment Result Questionnaire in patients with hand and wrist conditions: a prospective study.
        Clin Orthop Relat Res. 2021; 479: 2022-2032
        • Freemantle N.
        • Marston L.
        • Walters K.
        • Wood J.
        • Reynolds M.R.
        • Petersen I.
        Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research.
        BMJ. 2013; 347: f6409
        • Rosenbaum P.R.
        • Rubin D.B.
        The central role of the propensity score in observational studies for causal effects.
        Biometrika. 1983; 70: 41-55
        • Austin P.C.
        Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.
        Pharm Stat. 2011; 10: 150-161
        • Hahn S.
        Understanding noninferiority trials.
        Korean J Pediatr. 2012; 55: 403-407
        • Cohen J.
        Statistical Power Analysis for the Behavioural Science.
        2nd ed. Elsevier Science, 1988
        • Daly L.T.
        • Daly M.C.
        • Mohamadi A.
        • Chen N.
        Chronic scapholunate interosseous ligament disruption: a systematic review and meta-analysis of surgical treatments.
        Hand (N Y). 2020; 15: 27-34
        • Talwalkar S.C.
        • Edwards A.T.J.
        • Hayton M.J.
        • Stilwell J.H.
        • Trail I.A.
        • Stanley J.K.
        Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability.
        J Hand Surg Br. 2006; 31: 110-117