Park Andrew, Lutsky Kevin, Matzon Jonas, Leinberry Charlie, Chapman Talia, Beredjiklian Pedro K
Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA.
Department of Orthopaedic Surgery, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA.
J Hand Surg Am. 2018 Jun;43(6):545-549. doi: 10.1016/j.jhsa.2018.02.031. Epub 2018 Mar 28.
Wrist arthroscopy is generally considered the reference standard in the diagnosis of triangular fibrocartilage complex (TFCC) injuries. There is a paucity of data examining the reliability of wrist arthroscopy as a diagnostic modality for TFCC injuries. The goal of this study was to evaluate the interobserver and intraobserver reliability of the diagnosis of TFCC pathology during wrist arthroscopy.
Twenty-five intraoperative digital videos were captured by the senior author during diagnostic and surgical arthroscopy of the wrist joint for known or suspected articular pathology. The senior author (P.K.B.) confirmed TFCC resilience on visual inspection and ballottement (trampoline effect) to make the diagnosis. Two videos were excluded for poor quality and inadequate visualization. Three hand surgeons subsequently reviewed the remaining 23 videos in a blinded fashion at 2 time points separated by 4 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 κ coefficients were calculated.
Agreement between observers for the presence or absence of a tear was 66.7%. The average intraobserver agreement regarding the presence or absence of a tear was 67.4% The kappa value for interobserver agreement was 0.33, whereas the intrarater agreement was 0.88. The 3 reviewers identified an average of 11.3 positive trampoline tests. 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 3 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 that inter-rater reliability in the assessment of these tears is probably too low, reconsideration should be given to arthroscopy as the reference standard in the diagnosis of these tears.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
腕关节镜检查通常被认为是诊断三角纤维软骨复合体（TFCC）损伤的参考标准。关于腕关节镜作为TFCC损伤诊断方式的可靠性的数据较少。本研究的目的是评估腕关节镜检查期间TFCC病变诊断的观察者间和观察者内可靠性。
资深作者在腕关节诊断性和手术关节镜检查期间，针对已知或疑似关节病变拍摄了25个术中数字视频。资深作者（P.K.B.）通过视觉检查和冲击试验（蹦床效应）确认TFCC弹性以做出诊断。因质量差和可视化不足排除了2个视频。随后，3位手外科医生在相隔4周的2个时间点以盲法回顾了其余23个视频。审查者确定冲击试验是否为阳性以及是否存在TFCC撕裂。使用形态学分类对撕裂进行分类。计算包括一致性百分比和κ系数在内的可靠性统计指标。
观察者之间关于是否存在撕裂的一致性为66.7%。观察者内关于是否存在撕裂的平均一致性为67.4%。观察者间一致性的κ值为0.33，而观察者内一致性为0.88。3位审查者平均识别出11.3次阳性冲击试验。观察者之间关于阳性冲击试验的一致性为65.2%。观察者内关于阳性冲击试验的平均一致性百分比为49.3%。在所有3位审查者都同意存在TFCC撕裂的病例中，关于撕裂位置的一致性为76.6%。
腕关节镜检查在TFCC撕裂的治疗中仍然发挥着重要作用。然而，鉴于评估这些撕裂时观察者间的可靠性可能过低，应重新考虑将关节镜检查作为这些撕裂诊断的参考标准。
研究类型/证据水平：诊断性III级。
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