Wrist Arthroscopy Has Limited Inter And Intraobserver Reliability In The Assessment Of Tears Of The Triangular Fibrocartilage
Pedro Beredjiklian, MD; Kevin Lutsky, MD; Jonas Matzon, MD; Charles Leinberry, MD; Talia Chapman, MD; Andrew G. Park, MD
Thomas Jefferson University Hospital, Philadelphia, PA
Wrist arthroscopy is generally considered the "gold standard" in diagnosing triangular fibrocartilage complex (TFCC) injuries. There is a paucity of data examining the reliability of wrist arthroscopy as a diagnostic modaility for TFCC injuries. The goal of this study is to evaluate the inter-observer and intra-observer reliability of the diagnosis of TFCC pathology during wrist arthroscopy
Twenty-three intraoperative videos were captured by the senior author undergoing wrist arthroscopy for ulnar wrist pain with or without TFCC injuries. Videos were excluded for poor quality, inadequate visualization, or inadequate probing of pathologic lesions. Three hand surgeons subsequently reviewed the videos in a blinded fashion at two timepoints separated by four weeks. The reviewers determined if the trampoline test was positive and if a TFCC tear was present. Tears were classified using a morphologic classification. Statistical measures of reliability including percentage agreement and weighted ? coefficient were calculated.
The three reviewers identified an average of 15 TFCC tears. The percentage of agreement between observers for the presence or absence of a tear was 66.7%. The average percentage of intraobserver agreement regarding the presence or absence of a tear was 67.4% The three reviewers identified an average of 11.3 positive trampoline tests. The percentage of agreement between observers for a positive trampoline test was 65.2%. The average percentage of intraobserver agreement regarding a positive trampoline test was 49.3%. In cases where all three reviewers agreed on the presence of a TFCC tear, the agreement regarding tear location was 76.6%.
Wrist arthroscopy remains instrumental in the treatment of TFCC tears. However, given the high rate of disagreement between and within experienced observers, re-consideration should be given to its status as the "gold standard" in the diagnosis of these tears.
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