Patient-Reported and Clinical Outcomes After Tendon Autograft Reconstruction of the Thumb Ulnar Collateral Ligament.

PURPOSE: This study aimed to report clinical and patient-reported outcomes collected in a registry after thumb ulnar collateral ligament (UCL) reconstruction with a free tendon autograft. Furthermore, the patient-reported outcomes of patients with persistent instability after reconstruction and patients with concomitant metacarpophalangeal joint arthritis diagnosed during surgery were analyzed. METHODS: Patients undergoing reconstruction with a tendon autograft between December 2011 and February 2021 were included. Michigan Hand Outcomes Questionnaire (MHQ) scores at baseline were compared with those at 3 and 12 months after surgery. Stability was tested at 3 months after surgery. Tip and key pinch strength and metacarpophalangeal joint range of motion were measured at baseline and 12 months after surgery. RESULTS: We included 31 patients with thumb UCL insufficiency or failed UCL surgery who underwent reconstruction. The MHQ total score improved significantly from 62 at baseline to 75 at 3 months and continued to increase to 84 at 12 months after surgery. The MHQ function and pain scores improved significantly from intake to 3 and 12 months after surgery. Twenty-six of 31 patients (84%) regained postoperative metacarpophalangeal stability. Key pinch strength improved significantly 12 months after surgery from 5.2 kg at baseline to 6.4 kg at 12 months. The MHQ total, pain, and function scores of patients with persistent instability remained similar from baseline to 12 months after surgery. In four patients with metacarpophalangeal arthritis, the MHQ total and pain score improved significantly from baseline to 3 and 12 months after surgery. CONCLUSIONS: Patient-reported outcomes, including pain and function, improved after thumb UCL reconstruction with a tendon autograft. Although the sample size of patients with thumb metacarpophalangeal arthritis diagnosed during surgery was small, they reached adequate patient-reported outcomes at 12 months after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

The Ultrashort Mental Health Screening Tool Is a Valid and Reliable Measure With Added Value to Support Decision-making.

BACKGROUND: Mental health influences symptoms, outcomes, and decision-making in musculoskeletal healthcare. Implementing measures of mental health in clinical practice can be challenging. An ultrashort screening tool for mental health with a low burden is currently unavailable but could be used as a conversation starter, expectation management tool, or decision support tool. QUESTIONS/PURPOSES: (1) Which items of the Pain Catastrophizing Scale (PCS), Patient Health Questionnaire (PHQ-4), and Brief Illness Perception Questionnaire (B-IPQ) are the most discriminative and yield a high correlation with the total scores of these questionnaires? (2) What is the construct validity and added clinical value (explained variance for pain and hand function) of an ultrashort four-item mental health screening tool? (3) What is the test-retest reliability of the screening tool? (4) What is the response time for the ultrashort screening tool? METHODS: This was a prospective cohort study. Data collection was part of usual care at Xpert Clinics, the Netherlands, but prospective measurements were added to this study. Between September 2017 and January 2022, we included 19,156 patients with hand and wrist conditions. We subdivided these into four samples: a test set to select the screener items (n = 18,034), a validation set to determine whether the selected items were solid (n = 1017), a sample to determine the added clinical value (explained variance for pain and hand function, n = 13,061), and a sample to assess the test-retest reliability (n = 105). Patients were eligible for either sample if they completed all relevant measurements of interest for that particular sample. To create an ultrashort screening tool that is valid, reliable, and has added value, we began by picking the most discriminatory items (that is, the items that were most influential for determining the total score) from the PCS, PHQ-4, and B-IPQ using chi-square automated interaction detection (a machine-learning algorithm). To assess construct validity (how well our screening tool assesses the constructs of interest), we correlated these items with the associated sum score of the full questionnaire in the test and validation sets. We compared the explained variance of linear models for pain and function using the screening tool items or the original sum scores of the PCS, PHQ-4, and B-IPQ to further assess the screening tool's construct validity and added value. We evaluated test-retest reliability by calculating weighted kappas, ICCs, and the standard error of measurement. RESULTS: We identified four items and used these in the screening tool. The screening tool items were highly correlated with the PCS (Pearson coefficient = 0.82; p < 0.001), PHQ-4 (0.87; p < 0.001), and B-IPQ (0.85; p < 0.001) sum scores, indicating high construct validity. The full questionnaires explained only slightly more variance in pain and function (10% to 22%) than the screening tool did (9% to 17%), again indicating high construct validity and much added clinical value of the screening tool. Test-retest reliability was high for the PCS (ICC 0.75, weighted kappa 0.75) and B-IPQ (ICC 0.70 to 0.75, standard error of measurement 1.3 to 1.4) items and moderate for the PHQ-4 item (ICC 0.54, weighted kappa 0.54). The median response time was 43 seconds, against more than 4 minutes for the full questionnaires. CONCLUSION: Our ultrashort, valid, and reliable screening tool for pain catastrophizing, psychologic distress, and illness perception can be used before clinician consultation and may serve as a conversation starter, an expectation management tool, or a decision support tool. The clinical utility of the screening tool is that it can indicate that further testing is warranted, guide a clinician when considering a consultation with a mental health specialist, or support a clinician in choosing between more invasive and less invasive treatments. Future studies could investigate how the tool can be used optimally and whether using the screening tool affects daily clinic decisions. LEVEL OF EVIDENCE: Level II, diagnostic study.

Prevalence of Complications and Association With Patient-Reported Outcomes After Trapeziectomy With a Weilby Sling: A Cohort Study.

PURPOSE: The primary aim of this study was to report complications during the first year after trapeziectomy with Weilby sling using a standardized tool designed by the International Consortium for Health Outcome Measures. The secondary aim was to determine the association of complications and patient-reported outcomes 12 months after surgery. METHODS: We included patients who underwent trapeziectomy with Weilby sling between November 2013 and December 2018. All complications during the first year were scored using the International Consortium for Health Outcomes Measurement Complications in Hand and Wrist conditions (ICHAW) tool. Pain and hand function were measured before surgery and 12 months after surgery using the Michigan Hand Outcomes Questionnaire (MHQ). Minimally Important Change thresholds of 18.6 for MHQ pain and 9.4 for MHQ function were used to determine clinical importance. RESULTS: Of 531 patients after trapeziectomy with Weilby sling, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced Grade 2 or 3 deviations, including requiring antibiotics, corticosteroid injections, or additional surgery. On average, patients improved in pain and hand function, even in the presence of ICHAW events. Although all ICHAW grades were associated with poorer patient-reported outcomes 12 months after surgery, Grade 2 and 3 exceeded the Minimally Important Change threshold for pain and/or function. CONCLUSIONS: In 531 patients, 65% had an uneventful recovery, 16% experienced ICHAW Grade 1 deviations only, and 19% experienced grade 2 or 3 deviations. We recommend describing Grade 1 as "adverse protocol deviations" and grade 2 and 3 as complications, because of clinically relevant poorer patient-reported outcomes 12 months after surgery. The ICHAW is a promising tool to evaluate systematically and compare complications in hand surgery, although we recommend further evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Patient-Reported Outcomes and Function After Surgical Repair of the Ulnar Collateral Ligament of the Thumb.

PURPOSE: The purpose of this study was to report prospectively collected patient-reported outcomes of patients who underwent open thumb ulnar collateral ligament (UCL) repair and to find risk factors associated with poor patient-reported outcomes. METHODS: Patients undergoing open surgical repair for a complete thumb UCL rupture were included between December 2011 and February 2021. Michigan Hand Outcomes Questionnaire (MHQ) total scores at baseline were compared to MHQ total scores at three and 12 months after surgery. Associations between the 12-month MHQ total score and several variables (i.e., sex, injury to surgery time, K-wire immobilization) were analyzed. RESULTS: Seventy-six patients were included. From baseline to three and 12 months after surgery, patients improved significantly with a mean MHQ total score of 65 (standard deviation [SD] 15) to 78 (SD 14) and 87 (SD 12), respectively. We did not find any differences in outcomes between patients who underwent surgery in the acute (<3 weeks) setting compared to a delayed setting (<6 months). CONCLUSIONS: We found that patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. We did not find an association between injury to surgery time and lower MHQ total scores. This suggests that acute repair for full-thickness UCL tears might not always be necessary. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Patient-Reported Outcomes 1 Year After Proximal Interphalangeal Joint Arthroplasty for Osteoarthritis.

PURPOSE: Implant survival, range of motion, and complications of proximal interphalangeal joint arthroplasty have been reported often, but patient-reported outcomes are less frequently described. This study evaluated patients' experiences during the first year after proximal interphalangeal joint arthroplasty, measured with the Michigan Hand Outcomes Questionnaire (MHQ). The primary focus was the reduction of patient-reported pain after proximal interphalangeal joint implant placement and the percentage of patients who considered this reduction clinically relevant, indicated by the minimal clinically important difference (MCID). METHODS: Data were collected prospectively; 98 patients completed the MHQ before and at 3 and 12 months after surgery. Our primary outcome was the change in the pain score. An increase of 24 points or more was considered a clinically important difference. Secondary outcomes included changes in MHQ total and subscale scores and MCIDs, range of motion (ROM), patient satisfaction with the outcome of the surgery, and complications. RESULTS: The pain score improved significantly, from 42 (95% confidence interval, 38-46) at baseline to 65 (95% confidence interval, 60-69) at 12 months after surgery. The MCID was reached by 50% (n = 49) of patients. The ROM did not improve, reoperations occurred in 13% (n = 13) of patients, and swan neck deformities only occurred among surface replacement implants. CONCLUSIONS: Although most patients undergoing arthroplasty for osteoarthritis experienced significantly less pain after surgery, the pain reduction was considered clinically relevant in only 50% (n = 49) of patients. Patients with high MHQ pain scores before surgery are at risk for postoperative pain reduction that will not be clinically relevant. Likewise, the other subscales of the MHQ improved after surgery, but reached a clinically relevant improvement in only 46% (n = 45) to 63% (n = 62) of patients. This knowledge can be used during preoperative consultation to improve shared decision making. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Comparing Patient-Reported Outcomes on Three-Ligament Tenodesis between Partial and Complete Scapholunate Ligament Injuries: A Cohort Study.

PURPOSE: Multiple studies report outcomes after 3-ligament tenodesis (3-LT) in treating traumatic scapholunate interosseous ligament injury (SLIL). However, investigators do not differentiate between patients with partial or complete SLIL injury. The relation between the extent of SLIL disruption and surgical outcomes and if this should be considered when treating a patient with SLIL injury remains unknown. We aimed to evaluate differences in patient-rated wrist evaluation (PRWE) scores, satisfaction and return to work between patients with partial or complete chronic traumatic SLIL injury treated with 3 ligament tenodesis at 12 months after surgery. METHODS: All patients with chronic SLIL injury (partial and complete) who were treated with 3-LT at our clinic and received the same postoperative management between December 2011 and December 2019 were studied. Only patients who had completed the PRWE and return to work questionnaires preoperatively and 12 months after surgery were included. Patients were allocated to the partial (classified as Geissler 2 or 3) or complete SLIL injury group (classified as Geissler 4) by retrospectively assessing wrist arthroscopy reports. RESULTS: Thirty-nine patients with partial and 90 with complete SLIL injuries were included. At 1-year follow-up, PRWE scores had significantly improved in both groups. When adjusting for clinical baseline characteristics, there was no statistically significant difference between patients with partial or complete SLIL injury. Patients with complete SLIL injury had a 70% higher return to work within the first 12 months after 3-LT; however, satisfaction with the treatment result was similar for both study groups 1 year after surgery. CONCLUSIONS: Patients with complete and partial traumatic SLIL injury report better PRWE total scores at 12 months after 3-LT, but there was no statistically significant difference between the groups in PRWE scores or satisfaction with the treatment result. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Patients With Higher Treatment Outcome Expectations Are More Satisfied With the Results of Nonoperative Treatment for Thumb Base Osteoarthritis: A Cohort Study.

OBJECTIVE: To investigate how satisfaction with treatment outcome is associated with patient mindset and Michigan Hand Outcome Questionnaire (MHQ) scores at baseline and 3 months in patients receiving nonoperative treatment for first carpometacarpal joint (CMC-1) osteoarthritis (OA). DESIGN: Cohort study SETTING: A total of 20 outpatient locations of a clinic for hand surgery and hand therapy in the Netherlands. PARTICIPANTS: Patients (N=308) receiving nonoperative treatment for CMC-1 OA, including exercise therapy, an orthosis, or both, between September 2017 and February 2019. INTERVENTIONS: Nonoperative treatment (ie, exercise therapy, an orthosis, or both) MAIN OUTCOME MEASURES: Satisfaction with treatment outcomes was measured after 3 months of treatment. We measured total MHQ score at baseline and at 3 months. As baseline mindset factors, patients completed questionnaires on treatment outcome expectations, illness perceptions, pain catastrophizing, and psychological distress. We used multivariable logistic regression analysis and mediation analysis to identify factors associated with satisfaction with treatment outcomes. RESULTS: More positive pretreatment outcome expectations were associated with a higher probability of being satisfied with treatment outcomes at 3 months (odds ratio, 1.15; 95% confidence interval, 1.07-1.25). Only a relatively small part (33%) of this association was because of a higher total MHQ score at 3 months. None of the other mindset and hand function variables at baseline were associated with satisfaction with treatment outcomes. CONCLUSIONS: This study demonstrates that patients with higher pretreatment outcome expectations are more likely to be satisfied with treatment outcomes after 3 months of nonoperative treatment for CMC-1 OA. This association could only partially be explained by a better functional outcome at 3 months for patients who were satisfied. Health care providers treating patients nonoperatively for CMC-1 OA should be aware of the importance of expectations and may take this into account in pretreatment counseling.

Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain's Tenosynovitis?

BACKGROUND: Psychological factors such as depression, pain catastrophizing, kinesiophobia, pain anxiety, and more negative illness perceptions are associated with worse pain and function in patients at the start of treatment for de Quervain's tenosynovitis. Longitudinal studies have found symptoms of depression and pain catastrophizing at baseline were associated with worse pain after treatment. It is important to study patients opting for surgery for their condition because patients should choose surgical treatment based on their values rather than misconceptions. Psychological factors associated with worse patient-reported outcomes from surgery for de Quervain's tenosynovitis should be identified and addressed preoperatively so surgeons can correct any misunderstandings about the condition. QUESTION/PURPOSE: What preoperative psychosocial factors (depression, anxiety, pain catastrophizing, illness perception, and patient expectations) are associated with pain and function 3 months after surgical treatment of de Quervain's tenosynovitis after controlling for demographic characteristics? METHODS: This was a prospective cohort study of 164 patients who underwent surgery for de Quervain's tenosynovitis between September 2017 and October 2018 performed by 20 hand surgeons at 18 centers. Our database included 326 patients who underwent surgery for de Quervain's tenosynovitis during the study period. Of these, 62% (201 of 326) completed all baseline questionnaires and 50% (164 of 326) also completed patient-reported outcomes at 3 months postoperatively. We found no difference between those included and those not analyzed in terms of age, sex, duration of symptoms, smoking status, and workload. The mean ± SD age of the patients was 52 ± 14 years, 86% (141 of 164) were women, and the mean duration of symptoms was 13 ± 19 months. Patients completed the Patient-Rated Wrist Evaluation (PRWE), the VAS for pain and function, the Patient Health Questionnaire for symptoms of anxiety and depression, the Pain Catastrophizing Scale, the Credibility/Expectations Questionnaire, and the Brief Illness Perceptions questionnaire at baseline. Patients also completed the PRWE and VAS for pain and function at 3 months postoperatively. We used a hierarchical multivariable linear regression model to investigate the relative contribution of patient demographics and psychosocial factors to the pain and functional outcome at 3 months postoperatively. RESULTS: After adjusting for demographic characteristics, psychosocial factors, and baseline PRWE score, we found that only the patient's expectations of treatment and how long their illness would last were associated with the total PRWE score at 3 months postoperatively. More positive patient expectations of treatment were associated with better patient-reported pain and function at 3 months postoperatively (ß = -2.0; p < 0.01), while more negative patient perceptions of how long their condition would last were associated with worse patient-reported pain and function (timeline ß = 2.7; p < 0.01). The final model accounted for 31% of the variance in the patient-reported outcome at 3 months postoperatively. CONCLUSION: Patient expectations and illness perceptions are associated with patient-reported pain and functional outcomes after surgical decompression for de Quervain's tenosynovitis. Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. Prospective studies are needed to investigate whether addressing patient expectations and illness perceptions, with decision aids for example, can improve patient-reported pain and function postoperatively in those patients who still choose surgery for de Quervain's tenosynovitis. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Influence of Illness Perception and Mental Health on Return to Work After Carpal Tunnel Release Surgery.

PURPOSE: Although multiple factors influencing return to work after a carpal tunnel release (CTR) have been identified, little is known about the influence of psychological patient factors on return to work. Therefore, this study aimed to identify the psychological factors that play a role in the return to work after a CTR surgery. METHODS: Patients who planned to undergo a CTR were asked to fill out the Brief Illness Perception Questionnaire and the Patient Health Questionnaire before surgery to measure their illness perceptions and mental health status, respectively. Return to work was defined as the time until returning to work for 50% of normal hours and was measured using a questionnaire at 6 weeks, 3 months, and 6 months. To identify associations between nonpsychological and psychological patient factors and the return to work after CTR surgery, a Cox proportional hazards model was constructed. RESULTS: In total, 615 patients were included in our study. Six months after surgery, 91% of the patients returned to work. For the psychological patient factors, we found that increases of 1 point on the items of worrying about carpal tunnel syndrome and having faith preoperatively in a beneficial effect of the CTR surgery were associated with hazard ratios of 0.92 (95% confidence interval, 0.88-0.96) and 1.10 (95% confidence interval, 1.02-1.19), respectively, for returning to work in the first 6 months after surgery. An increase of 1 point on the depression subscale of the Patient Health Questionnaire was associated with a hazard ratio of 0.88 (95% confidence interval, 0.78-0.99) for returning to work in the first 6 months after surgery. CONCLUSIONS: Our study showed that multiple psychological patient factors are associated with return to work after a CTR surgery. Addressing these psychological factors before surgery might be a low-cost intervention to improve return to work after the CTR surgery. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Item reduction of the 39-item Rotterdam Diabetic Foot Study Test Battery using decision tree modelling.

AIMS: Pedal sensory loss due to diabetes-related neuropathy can be graded by testing static two-point discrimination (S2PD), moving two-point discrimination (M2PD), static one-point discrimination (S1PD; eg, 10-g monofilament), and vibration sense and is included in the Rotterdam Diabetic Foot (RDF) Study Test Battery. The aim of this study is to investigate if decision tree modelling is able to reduce the number of tests needed in estimating pedal sensation. METHODS: The 39-item RDF Study Test Battery (RDF-39) scores were collected from the prospective RDF study and included baseline (n = 416), first follow-up (n = 364), and second follow-up (n = 135) measurements, supplemented with cross-sectional control data from a previous study (n = 196). Decision tree analysis was used to predict total RDF-39 scores using individual test item data. The tree was developed using baseline RDF study data and validated in follow-up and control data. Spearman correlation coefficients assessed the reliability between the decision tree and original RDF-39. RESULTS: The tree reduced the number of items from 39 to 3 in estimating the RDF-39 sum score. M2PD (hallux), S2PD (first dorsal web, fifth toe), vibration sense (interphalangeal joint), and S1PD (first dorsal web, fifth toe) measurements proved to be predictive. The correlation coefficients to original scores were high (0.76 to 0.91). CONCLUSIONS: The decision tree was successful at reducing the number of RDF Test Battery items to only 3, with high correlation coefficients to the scores of the full test battery. The findings of this study aids medical decision making by time efficiently estimating pedal sensory status with fewer tests needed.

Illness Perceptions of Patients With First Carpometacarpal Osteoarthritis, Carpal Tunnel Syndrome, Dupuytren Contracture, or Trigger Finger.

PURPOSE: Previous studies indicate that patients with a more negative perception of their illness tend to respond less favorably to treatment, but little is known about whether illness perceptions differ based on the type of hand or wrist conditions. Therefore, we compared illness perceptions between patients scheduled to undergo surgery for 4 illnesses in hand surgery: carpometacarpal osteoarthritis (CMC OA), Dupuytren disease, carpal tunnel syndrome (CTS), and trigger finger syndrome (TFS). We hypothesized there would be differences in illness perception between these patient groups. METHODS: Before surgery, patients were asked to complete the Brief Illness Perception Questionnaire (Brief-IPQ) as part of routine outcome measurement in a specialized hand and wrist surgery clinic. The Brief-IPQ is a validated questionnaire to rapidly assess the cognitive and emotional representation of illness. Differences in illness perception between the 4 diagnostic groups, corrected for age, sex, hand dominance, and work type, were examined. Cohen D effect sizes were calculated for the between-group differences. RESULTS: We included 514 patients in the analyses: 87 with CMC OA, 146 with Dupuytren disease, 129 with CTS, and 152 with TFS. On a scale ranging from 0 (most positive perception) to 80 (most negative perception) the Brief-IPQ sum scores for these subgroups were 42.0, 28.2, 38.8, and 33.3, respectively. Corrected for age, sex, hand dominance, and work type, patients with Dupuytren disease had a more positive perception of their illness than patients with CMC OA and CTS. Compared with CMC OA patients, the effect sizes for Dupuytren, CTS, and TFS patients were, respectively, 1.28, 0.32, and 0.81. CONCLUSIONS: In these patients with various hand/wrist disorders, differences were found in their preoperative perceptions of illness. Interventions that directly target negative illness perceptions might improve treatment outcomes for CMC OA and CTS. CLINICAL RELEVANCE: These differences should be considered during preoperative medical consultations and/or when investigating surgical outcomes.

Predicting ulcer-free survival using the discriminative value of screening test locations.

BACKGROUND: Current guidelines recommend screening the feet of diabetic subjects with a 10-g monofilament or tuning fork. We investigated which tests and locations on the feet have the best predictive value regarding 1-year ulcer-free survival in diabetic subjects participating in the prospective Rotterdam Diabetic Foot Study. METHODS: Decision tree analysis was used to predict ulcer-free survival based on responses from individual test locations (monofilaments on 10 sites, vibration sense was tested on both halluces and medial malleoli). Separate trees for patients with and without a history of diabetic foot ulcer (DFU) were developed. RESULTS: Four hundred sixteen subjects (mean [SD] age, 61.8 years [12.4]; range, 21.6-90.2) were measured, of whom 24 developed new DFUs. Three tests exhibited discriminative and predictive properties: testing vibration sense on the medial malleolus and monofilament testing on heel and hallux. The decision tree to predict ulcer-free survival in patients with a history of DFU yielded a sensitivity of 87.0%, which was 99.6% for the tree of patients without a history of DFU. CONCLUSION: The findings of this study aids medical decision making by discriminating between high- and low-risk patients of developing DFU using selective testing on sites with predictive properties.

Which Psychological Variables Are Associated With Pain and Function Before Surgery for de Quervain's Tenosynovitis? A Cross-sectional Study.

BACKGROUND: Depression, anxiety, and pain catastrophizing have been associated with worse pain and function in studies of patients with de Quervain's tenosynovitis. Illness perceptions are the patient's thoughts and feelings about their illness. More negative perceptions of the illness such as the illness having a long duration or serious consequences are associated with worse physical function in patients with hand osteoarthritis. It is currently unknown whether these psychological factors play a similar role in de Quervain's. We chose to study patients who have tried nonoperative management and have chosen surgical decompression due to persistent symptoms. Psychological factors may be associated with their ongoing pain and impaired function, so it is particularly important to investigate the role of psychosocial factors that may be targeted with non-invasive interventions. QUESTIONS/PURPOSES: Which psychological variables are independently associated with baseline pain and function in patients undergoing surgical treatment for de Quervain's tenosynovitis, after controlling for clinical and demographic variables? METHODS: This cross-sectional study included data from a longitudinally maintained database on 229 patients who had surgery for de Quervain's tenosynovitis between September 2017 and October 2018. All management options were discussed with patients, but many had already tried nonoperative management and chose surgery once referred to our institution. Our database included 958 patients with de Quervain's, with 69% (659) managed nonoperatively and 34% (326 of 958) who underwent surgical decompression. A total of 70% (229 of 958) completed all questionnaires and could be included in the study. With the numbers available, we found no differences between those included and those not analyzed in terms of age, gender, duration of symptoms, BMI, smoking status, and workload.Patients completed the Patient-Rated Wrist/Hand Evaluation (PRWHE), Patient Health Questionnaire for emotional distress, Pain Catastrophizing Scale (PCS), and the Brief Illness Perception Questionnaire. We investigated the relative contribution of patient demographics and individual psychosocial factors using a hierarchical multivariable linear regression model. In the first step we considered how demographic factors were associated with the baseline PRWHE score. In the second step we investigated the effect of pain catastrophizing and emotional distress on the baseline PRWHE score after accounting for confounding demographic factors. In the final step, the effect of illness perceptions on baseline PRWHE were considered after accounting for the confounding effects of demographic factors as well as pain catastrophizing and emotional distress. RESULTS: After controlling for confounding variables including workload and emotional distress, a more negative patient perception of the consequences of their condition and worse pain catastrophizing were associated with worse pain and function (consequences, ß = 0.31; p < 0.01, pain catastrophizing ß = 0.17; p = 0.03). A hierarchical multivariable regression analysis found that 11% of variance in baseline pain and function was explained by pain catastrophizing and emotional distress. Illness perceptions brought the total explained variance of the final model to 34%. CONCLUSIONS: More negative perceptions of the consequences of de Quervain's tenosynovitis and worse pain catastrophizing are associated with worse pain and reduced function at baseline in patients awaiting surgical decompression of de Quervain's tenosynovitis. In light of these findings, future studies might explore interventions to reduce pain catastrophizing and lower the perceived consequences of the condition. This may reduce the number of patients choosing surgical decompression or may also improve surgical outcomes. Further work should consider if these psychological factors are also associated with postoperative patient-reported outcomes. LEVEL OF EVIDENCE LEVEL: III, therapeutic study.

Patients With Thumb-base Osteoarthritis Scheduled for Surgery Have More Symptoms, Worse Psychological Profile, and Higher Expectations Than Nonsurgical Counterparts: A Large Cohort Analysis.

BACKGROUND: Psychological characteristics, such as depression, anxiety or negative illness perception are highly prevalent in patients with several types of OA. It is unclear whether there are differences in the clinical and psychological characteristics of patients with thumb carpometacarpal (CMC-1) osteoarthritis (OA) scheduled for nonsurgical treatment and those with surgical treatment. QUESTIONS/PURPOSES: (1) What are the differences in baseline sociodemographic characteristics and clinical characteristics (including pain, hand function, and health-related quality of life) between patients with thumb CMC-1 OA scheduled for surgery and those treated nonoperatively? (2) What are the differences in psychological characteristics between patients scheduled for surgery and those treated nonsurgically, for treatment credibility, expectations, illness perception, pain catastrophizing, and anxiety and depression? (3) What is the relative contribution of baseline sociodemographic, clinical, and psychological characteristics to the probability of being scheduled for surgery? METHODS: This was a cross-sectional study using observational data. Patients with CMC-1 OA completed outcome measures before undergoing either nonsurgical or surgical treatment. Between September 2017 and June 2018, 1273 patients were screened for eligibility. In total, 584 participants were included: 208 in the surgery group and 376 in the nonsurgery group. Baseline sociodemographic, clinical, and psychological characteristics were compared between groups, and a hierarchical logistic regression analysis was used to investigate the relative contribution of psychological characteristics to being scheduled for surgery, over and above clinical and sociodemographic variables. Baseline measures included pain, hand function, satisfaction with the patient's hand, health-related quality of life, treatment credibility and expectations, illness perception, pain catastrophizing, and anxiety and depression. RESULTS: Patients in the surgery group had longer symptom duration, more often a second opinion, higher pain, treatment credibility and expectations and worse hand function, satisfaction, HRQoL, illness perception and pain catastrophizing compared with the non-surgery group (effect sizes ranged from 0.20 to 1.20; p values ranged from < 0.001 to 0.044). After adjusting for sociodemographic, clinical, and psychological factors, we found that the following increased the probability of being scheduled for surgery: longer symptom duration (standardized odds ratio [SOR], 1.86; p = 0.004), second-opinion visit (SOR, 3.81; p = 0.027), lower satisfaction with the hand (SOR, 0.65; p = 0.004), higher treatment expectations (SOR, 5.04; p < 0.001), shorter perceived timeline (SOR, 0.70; p = 0.011), worse personal control (SOR, 0.57; p < 0.001) and emotional response (SOR, 1.40; p = 0.040). The hierarchical logistic regression analysis including sociodemographic, clinical, and psychological factors provided the highest area under the curve (sociodemographics alone: 0.663 [95% confidence interval 0.618 to 0.709]; sociodemographics and clinical: 0.750 [95% CI 0.708 to 0.791]; sociodemographics, clinical and psychological: 0.900 [95% CI 0.875 to 0.925]). CONCLUSIONS: Patients scheduled to undergo surgery for CMC-1 OA have a worse psychological profile than those scheduled for nonsurgical treatment. Our findings suggest that psychological characteristics should be considered during shared decision-making, and they might indicate if psychological interventions, training in coping strategies, and patient education are needed. Future studies should prospectively investigate the influence of psychological characteristics on the outcomes of patients with CMC-1 OA. LEVEL OF EVIDENCE: Level III, therapeutic study.

Reconstruction of an early stage SLAC wrist with the 3-LT procedure: A controversial reappraisal.

OBJECTIVE: We hypothesized that the three-ligament tenodesis (3-LT) procedure is still sufficient - even in scapholunate advanced collapse (SLAC) cases - to reduce pain and improve wrist function. We compared patient-reported outcomes of scapholunate interosseus ligament (SLIL) injury patients with SLAC to SLIL injury patients treated with 3-LT, and then to patients who received proximal row carpectomy (PRC), as a control group. METHOD: We included all patients with a traumatic SLIL injury and associated SLAC components treated with 3-LT and completed Patient Reported Wrist Evaluation (PRWE) questionnaires preoperative and at 12 months follow-up. First, we compared matched patients with SLIL injury and SLIL injury with SLAC, stage 1-3, who received 3-LT. Second, we compared patients who received 3-LT, with patients who underwent PRC, while having SLAC stage 2-3. RESULTS: We compared 51 patients with SLAC to 95 with SLIL injury who had a 3-LT procedure, and 10 3-LT patients were compared to 18 patients undergoing PRC, given SLAC 2-3. In both analyses, the PRWE scores had significantly improved in all groups, however no significant differences in PRWE were found between 3-LT in SLIL injury and SLIL injury with SLAC, 6.9 points (95% CI [-14.92; 1.22], p = 0.096) and between 3-LT and PRC, given SLAC stage 2-3, 15.1 points (not enough power). CONCLUSION: There is no difference in PRWE between matched SLIL injury patients with or without degenerative changes treated with a 3-LT. Therefore, the 3-LT procedure seems to be a viable treatment option for patients with early-stage SLAC wrist. LEVEL OF EVIDENCE: Therapeutic III.

Reconstruction of Partial Hypopharyngeal Defects following Total Laryngectomy: A Systematic Review and Meta-Analysis.

BACKGROUND: Various operative techniques exist to reconstruct partial hypopharyngeal defects following total laryngectomy. The current study aimed to investigate and compare complications and functional results following commonly used reconstructive techniques. METHODS: A systematic review and meta-analysis were performed using studies that investigated outcomes after the reconstruction of a partial hypopharyngeal defect. The outcomes of interest were fistulas, strictures, flap failure, swallowing function and postoperative speech. RESULTS: Of the 4035 studies identified, 23 were included in this review. Four common reconstructive techniques were reported, with a total of 794 patients: (1) pectoralis major myocutaneous and (2) myofascial flap, (3) anterolateral thigh free flap and (4) radial forearm free flap. Fistulas occurred significantly more often than pectoralis major myocutaneous flaps (34%, 95% CI 23-47%) compared with other flaps (p < 0.001). No significant differences in the rates of strictures or flap failure were observed. Pectoralis major myofascial flaps were non-inferior to free-flap reconstructions. Insufficient data were available to assess speech results between flap types. CONCLUSION: Pectoralis myocutaneous flaps should not be the preferred method of reconstruction for most patients, considering their significantly higher rate of fistulas. In contrast, pectoralis major myofascial flaps yield promising results compared to free-flap reconstructions, warranting further investigation.

Surgical Techniques in Non-Traumatic Midcarpal Instability: Evaluating the Dorsal Capsulodesis and Three-Ligament Tenodesis Technique.

BACKGROUND: Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial due to limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, patient satisfaction, range of motion, and return to work in patients with non-traumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or three-ligament tenodesis (3LT). METHODS: Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation (PRWE) and Satisfaction with Treatment Result Questionnaire at 12 months postoperative. All data were retrospectively analyzed. RESULTS: A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December 2011 and December 2019 were included. At twelve months postoperative, both treatment groups reported significant improvements in pain and function scores. However, at three months postoperative, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return to work (72%) compared to the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at three months which was restored at 12 months postoperative. No significant difference in satisfaction with treatment was observed. CONCLUSIONS: Both 3LT and dorsal capsulodesis demonstrate promising results for addressing non-traumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, we recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient. LEVEL OF EVIDENCE: III.

Clinical outcomes after primary repair for thumb ulnar collateral ligament ruptures: a systematic review and meta-analysis.

There is no consensus on the best surgical technique for treating thumb ulnar collateral ligament (UCL) ruptures. This systematic review and meta-analysis investigates which primary repair technique and postoperative immobilization protocol result in the best clinical outcomes. A literature search was conducted in Embase, Medline ALL Ovid, Web of Science Core Selection and Cochrane Central Register of Controlled Trials. Pain, stability, tip pinch strength, key pinch strength, grip strength, return to work and metacarpophalangeal joint range of motion were collected as postoperative outcomes. In total, 29 studies were included. All surgical techniques resulted in satisfactory clinical outcomes, with no significant differences between bone anchor reinsertion, suture fixation, K-wire fixation and a combination of techniques. K-wire immobilization resulted in worse postoperative pain, but similar stability compared to immobilization without a K-wire. Clinical outcomes after thumb UCL repair are excellent, with no differences in clinical outcomes noted among surgical techniques.

Recurrence rate and patient-reported outcomes after wedge excision of carpal boss.

The treatment of carpal boss is primarily conservative. Surgical treatment by performing a wedge excision of the bony protrusion, is possible. However, a common belief exists that carpal boss should not be operated because of the high recurrence rate. Additionally, little is known about the clinical outcomes of wedge excision and the preferred post-operative treatment. Patients with carpal boss and persisting pain who underwent wedge excision after conservative treatment were included. They received questionnaires before and three months after surgery. The primary outcomes were pain and hand function measured using patient-reported wrist evaluations (PRWE). Secondarily, recurrence, patient satisfaction and time until return to work were evaluated. These clinical outcomes were also compared between patients who received a plaster splint or a pressure dressing post-operatively. 76 patients were included. Three months after surgery, a significant improvement in PRWE was seen, for both pain and function. A re-operation rate for recurrent carpal boss of 13% was observed. After three months, 58% of patients were satisfied and 73% had returned to work. While no differences in clinical outcomes were found, patients were more satisfied after receiving a pressure dressing than a plaster splint post-operatively. The current study demonstrates encouraging early outcomes after wedge excision, and a low recurrence re-operation rate. Furthermore, a pressure dressing seems preferable post-operatively compared to a plaster splint.