The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies

Löw, Steffen; Erne, H.; Schütz, Alexander; Eingartner, C.; Spies, Claudia

doi:10.1007/s00402-015-2339-y

Cited by 15 publications

(10 citation statements)

References 16 publications

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“…If necessary, additional instruments were inserted, for example to execute the push-off needle test [27]. As recommended by Löw et al, adequate photo and video documentation of arthrographies was performed to enhance intra-and interobserver reliability [28,29]. In the remaining 84 patients, no surgical exploration was realized based on wrist stability in clinical assessment and imaging results.…”

Section: Reference Standardmentioning

confidence: 99%

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

Grunz

Gietzen

Luetkens

et al. 2020

BMC Musculoskelet Disord

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Background: Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods: One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPR Standard), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPR Styloid) or in the ulnar fovea (MPR Fovea). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer's and Atzei's classification and diagnostic confidence was stated on a fivepoint Likert scale.

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Section: Reference Standardmentioning

confidence: 99%

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

Grunz

Gietzen

Luetkens

et al. 2020

BMC Musculoskelet Disord

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“…Cartilage assessment already differs among surgeons, when they scope the same patients one-by-one, 1 the quality of assessment diminishes further by inadequate documentation. Löw et al 6 have examined the interobserver diagnoses based on video documents of different lengths. In their study, surgeons rated twice as many false-positive cartilage lesions when viewing short videos compared with when viewing long video sequences.…”

Section: Discussionmentioning

confidence: 99%

“…2 On the other hand, insufficient photo or video documentation impedes others from reproducing what was diagnosed during arthroscopy. [3][4][5][6] Therefore, for those who perform definitive treatment, repeat arthroscopy serves to get an own idea of the wrists' status. Studies reporting on the incidence and causes for revision arthroscopies in larger joints are numerous.…”

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confidence: 99%

Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

et al. 2016

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Frequently, patients undergo repeated wrist arthroscopies for single wrist problems. The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures. For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies. Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists. In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures. Level IV.

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“…9 Arthro-scopy was performed in a standardized fashion with the wrists thoroughly examined and documented as has been described in the literature. 3,10 If arthroscopy revealed a central TFC perforation (►Fig. 1), the lesions' margins were first resected by the use of a punch (►Video 1) and then debrided using an oscillating shaver (►Video 2).…”

Section: Methodsmentioning

confidence: 99%

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

et al. 2017

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Arthroscopic debridement of the triangular fibrocartilage (TFC) is well accepted in patients with ulnar impaction syndrome with central TFC lesions. Treatment remains controversial, however, when there is no such lesion from radiocarpal view. This study assessed the clinical outcome of arthroscopic central TFC resection and debridement and secondary ulnar shortening in patients with ulnar impaction with central TFC lesion compared with patients without TFC lesion. Thirty-two consecutive patients with ulnar impaction syndrome were arthroscopically treated, 16 of whom had a central lesion of the TFC that was debrided. In the 16 patients with no lesion from the radiocarpal view, the TFC was centrally resected and debrided to decompress the ulnocarpal joint. Persisting symptoms necessitated ulnar shortening in four patients in each group. Two patients underwent repeat arthroscopic TFC debridement. All patients were examined at 3, 6, and 12 months, and at final follow-up (mean: 1.7 years) following arthroscopy, respectively ulnar shortening or hardware removal. In both groups, pain, Krimmer, and DASH scores significantly improved. Improvements of DASH scores were significantly higher in patients without lesion at 12 months and at final follow-up. For other parameters, no significant difference was found between the two groups. In both situations, with and without central TFC lesion, resection and debridement sufficiently reduced the ulnar-sided wrist pain and improved function in three out of four patients, and therefore qualified as the first-line treatment of ulnar impaction syndrome as arthroscopy is performed, anyway. Those patients who complained of persisting or recurrent ulnar-sided wrist pain finally benefitted from ulnar shortening osteotomy as the secondary procedure. Therapeutic III, case-control study.

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The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies

Abstract: Diagnostic II.

Cited by 15 publications

References 16 publications

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist

Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

Treatment of Ulnar Impaction Syndrome with and without Central TFC Lesion

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