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Patient-Rated Wrist Evaluation Threshold for Successful Open Surgery of the Triangular Fibrocartilage Complex
Reinier Feitz1, Yara E van Kooij1,2,3, Mark J W van der Oest1,4
1Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.
Journal of Wrist Surgery
|July 19, 2024
Summary
A baseline Patient-Rated Wrist Evaluation (PRWE) score below 34 indicates a low likelihood of achieving clinically improved outcomes after triangular fibrocartilage complex (TFCC) surgery. Patients with higher baseline PRWE scores are more likely to experience significant improvement.
Area of Science:
- Orthopedic Surgery
- Patient-Reported Outcomes
- Wrist Biomechanics
Background:
- Triangular fibrocartilage complex (TFCC) tears are a common cause of wrist pain.
- Surgical intervention for TFCC tears aims to restore function and alleviate pain.
- Identifying predictors of successful surgical outcomes is crucial for patient selection.
Purpose of the Study:
- To establish baseline thresholds using patient-reported outcome measures (PROMs) for patients undergoing TFCC surgery.
- To identify patient characteristics associated with clinically meaningful improvements post-TFCC repair.
- To guide surgical decision-making by predicting treatment success.
Main Methods:
- A cohort of patients undergoing open TFCC repair completed the Patient-Rated Wrist Evaluation (PRWE) questionnaire at baseline and 12 months postoperatively.
- The minimal clinically important difference (MCID) for the PRWE was determined using an anchor-based method (MCID = 24).
- Statistical analyses (t-tests, chi-square tests) compared patient, disease, and surgical factors between those who achieved MCID and those who did not.
Main Results:
- Patients with a longer history of symptoms were less likely to reach the MCID.
- A baseline PRWE score <34 was associated with a significantly lower chance of achieving the MCID (14% success rate).
- Conversely, patients with a baseline PRWE score ≥34 demonstrated a higher success rate (69% achieved MCID).
Conclusions:
- A baseline PRWE score below 34 serves as a critical indicator to reconsider open TFCC surgery.
- Patients with lower baseline PRWE scores have a diminished likelihood of achieving clinically significant outcomes.
- This finding supports using baseline PROMs to optimize patient selection for TFCC surgical repair.
