Purpose
The aim of this study was to evaluate the prognostic value of preoperative patient-reported
outcomes as predictors of functional improvement following ligament reconstruction
tendon interposition. We hypothesized that high levels of preoperative pain interference
(PI) and upper-extremity disability are associated with lower magnitudes of functional
improvement ≥1 year after surgery on the shortened version of the Disabilities of
the Arm, Shoulder, and Hand (QuickDASH) (primary outcome) and Patient-Reported Outcomes Measurement Information System
Upper Extremity (UE) Computer Adaptive Test (CAT) (UE CAT) v1.2 (secondary outcome).
Methods
Adult patients who underwent ligament reconstruction tendon interposition between
February 2014 and April 2018 at an academic tertiary institution were considered for
inclusion in this longitudinal cohort study. Patient-reported outcomes were collected
at baseline and ≥1 year after surgery. Univariate and multivariable linear regression
analyses were performed to identify factors associated with the magnitude of functional
improvement on the QuickDASH and UE CAT.
Results
Among 93 included participants, the mean age was 61 ± 7 years, and 75 (81%) were women.
At 2.5 ± 1.0 years after surgery, the QuickDASH and UE CAT improved by a mean of 24.5 ± 20.9 and 9.9 ± 10.7 points, respectively.
In the primary multivariable model, a greater preoperative QuickDASH (indicative of lower function; coefficient, 0.8; 95% confidence interval [CI],
0.6 to 0.9) and lower preoperative Performance of Patient-Reported Outcomes Measurement
Information System PI CAT (eg, less pain interference; coefficient, −0.7; 95% CI, −1.2
to −0.2) were associated with greater QuickDASH improvement independent of potential confounders. In the secondary multivariable
model, lower preoperative UE CAT (indicative of worse function; coefficient, −0.9;
95% CI, −1.1 to −0.7) and lower preoperative Patient-Reported Outcomes Measurement
Information System PI CAT (coefficient, −0.3; 95% CI, −0.6 to −0.1) were associated
with greater UE CAT improvement.
Conclusions
Preoperative patient-reported outcomes may be useful in understanding the degree of
improvement that certain patient populations can expect from ligament reconstruction
tendon interposition. Those with lower baseline (preoperative) upper-extremity function
and PI are expected to derive the greatest functional improvement in the midterm.
Type of study/level of evidence
Prognostic IV.
Key Words
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Article info
Publication history
Published online: December 31, 2022
Accepted:
November 2,
2022
Received:
June 3,
2022
Footnotes
J.C. and M.J.R contributed equally to this work.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2023 by the American Society for Surgery of the Hand. All rights reserved.
