Minimal invasions: is wrist arthroscopy supported by evidence? A systematic review and meta-analysis
DOI:
https://doi.org/10.2340/17453674.2023.11957Keywords:
ArthroscopyAbstract
Background and purpose: Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures.
Methods: We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention.
Results: Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise.
Conclusion: The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
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Karelson M C, Jokihaara J, Launonen A P, Huttunen T, Mattila V M. Lower nationwide rates of arthroscopic procedures in 2016 compared with 1997 (634925 total arthroscopic procedures): has the tide turned? Br J Sports Med 2021; 55(18): 1018-23. doi: 10.1136/bjsports-2019-101844. DOI: https://doi.org/10.1136/bjsports-2019-101844
Cooney W P. Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy. J Hand Surg Am 1993; 18(5): 815-22. doi: 10.1016/0363-5023(93)90047-7. DOI: https://doi.org/10.1016/0363-5023(93)90047-7
Chloros G D, Wiesler E R, Poehling G G. Current concepts in wrist arthroscopy. Arthroscopy 2008; 24(3): 343-54. doi: 10.1016/j.arthro.2007.10.006. DOI: https://doi.org/10.1016/j.arthro.2007.10.006
Bawale R, Singh B. A review of wrist arthroscopy of wrist surgery: an experience at a district general hospital. Orthopaedic Proceedings 2013; 95-B(SUPP_19): 32. doi: 10.1302/1358-992X.95BSUPP_19.IOSUK2011-032.
Chloros G D, Shen J, Mahirogullari M, Wiesler E R. Wrist arthroscopy. J Surg Orthop Adv 2007; 16(2): 49-61.
Nakamura T, Cheong Ho P, Atzei A, Corella F, Haugstvedt J R. Revolutions in arthroscopic wrist surgeries. J Hand Surg (European Volume) 2021; 47(1): 52-64. doi: 10.1177/17531934211030861. DOI: https://doi.org/10.1177/17531934211030861
Ho P C, Tse W L, Wong C W yee, Hung L K. Advances in arthroscopic surgery of the wrist: from resection to reconstruction. Medicina Fluminensis 2015; 51(1): 52-89.
Burnier M, Herzberg G, Luchetti R, Del Piñal F, Kakar S. Dry wrist arthroscopy for ulnar-sided wrist disorders. J Hand Surg Am 2021; 46(2): 133-41. doi: 10.1016/j.jhsa.2020.08.011. DOI: https://doi.org/10.1016/j.jhsa.2020.08.011
Page M J, McKenzie J E, Bossuyt P M, Boutron I, Hoffmann T C, Mulrow C D, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021 Mar 29; 372:n71. doi: 10.1136/bmj.n71 DOI: https://doi.org/10.1136/bmj.n71
Hudak P L, Amadio P C, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med 1996; 29(6): 602-8. doi: 10.1002/(SICI)1097-0274(199606)29:6<602::AIDAJIM4>3.0.CO;2-L. DOI: https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
Franchignoni F, Vercelli S, Giordano A, Sartorio F, Bravini E, Ferriero G. Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther 2014; 44(1): 30-9. doi: 10.2519/jospt.2014.4893. DOI: https://doi.org/10.2519/jospt.2014.4893
Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. GRADE Working Group; 2013, https://www.gradeworkinggroup.org/.
Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010; 36(3): 1-48. doi: 10.18637/jss.v036.i03. DOI: https://doi.org/10.18637/jss.v036.i03
Balduzzi S, Rücker G, Schwarzer G. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 2019; 22(4): 153-60. doi: 10.1136/ebmental-2019-300117. DOI: https://doi.org/10.1136/ebmental-2019-300117
R Core Team. R: A Language and environment for statistical computing. Vienna, Austria R Foundation for Statistical Computing; 2020.
RStudio Team. RStudio: Integrated development environment for R. Boston, MA: RStudio Team; 2020.
Higgins J P T, Altman D G, Sterne J A C. Assessing risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions Version 510; 2011. Chapter 8.
GRADE Working Group. GRADEpro guideline development tool [software]. Hamilton, Ontario: McMaster University and Evidence Prime; 2021.
Doi K, Hattori Y, Otsuka K, Abe Y, Yamamoto H. Intra-articular fractures of the distal aspect of the radius: arthroscopically assisted reduction compared with open reduction and internal fixation. J Bone Joint Surg Am 1999; 81(8): 1093-110. doi: 10.2106/00004623-199908000-00005. DOI: https://doi.org/10.2106/00004623-199908000-00005
Varitimidis S E, Basdekis G K, Dailiana Z H, Hantes M E, Bargiotas K, Malizos K. Treatment of intra-articular fractures of the distal radius. J Bone Joint Surg Br 2008; 90(6): 778-85. doi: 10.1302/0301620X.90B6.19809. DOI: https://doi.org/10.1302/0301-620X.90B6.19809
Yamazaki H, Uchiyama S, Komatsu M, Hashimoto S, Kobayashi Y, Sakurai T, et al. Arthroscopic assistance does not improve the functional or radiographic outcome of unstable intra-articular distal radial fractures treated with a volar locking plate: a randomised controlled trial. Bone Joint J 2015; 97-B(7): 957-62. doi: 10.1302/0301-620X.97B7.35354. DOI: https://doi.org/10.1302/0301-620X.97B7.35354
Kang L, Akelman E, Weiss A P C. Arthroscopic versus open dorsal ganglion excision: a prospective, randomized comparison of rates of recurrence and of residual pain. J Hand Surg Am 2008; 33(4): 471-5. doi: 10.1016/j.jhsa.2008.01.009. DOI: https://doi.org/10.1016/j.jhsa.2008.01.009
Rocchi L, Canal A, Fanfani F, Catalano F. Articular ganglia of the volar aspect of the wrist: arthroscopic resection compared with open excision. A prospective randomised study. Scand J Plast Reconstr Surg Hand Surg 2008; 42(5): 253-9. doi: 10.1080/02844310802210897. DOI: https://doi.org/10.1080/02844310802210897
Selles C A, Mulders M A M, Colaris J W, van Heijl M, Cleffken B I, Schep N W L. Arthroscopic debridement does not enhance surgical treatment of intra-articular distal radius fractures: a randomized controlled trial. J Hand Surg Eur 2020; 45(4): 327-32. doi: 10.1177/1753193419866128. DOI: https://doi.org/10.1177/1753193419866128
Lee S K, Kim K J, Cha Y H, Choy W S. Conservative treatment is sufficient for acute distal radioulnar joint instability with distal radius fracture. Ann Plast Surg 2016; 77(3): 297-304. doi: 10.1097/SAP.0000000000000663. DOI: https://doi.org/10.1097/SAP.0000000000000663
del Piñal F, Klausmeyer M, Thams C, Moraleda E, Galindo C. Early experience with (dry) arthroscopic 4-corner arthrodesis: from a 4-hour operation to a tourniquet time. J Hand Surg Am 2012; 37(11): 2389-99. doi: 10.1016/j.jhsa.2012.08.026. DOI: https://doi.org/10.1016/j.jhsa.2012.08.026
Del Piñal F, Clune J. Arthroscopic management of intra-articular malunion in fractures of the distal radius. Hand Clin 2017; 33(4): 669-75. doi: 10.1016/j.hcl.2017.07.004. DOI: https://doi.org/10.1016/j.hcl.2017.07.004
Del Piñal F. Arthroscopic volar capsuloligamentous repair. J Wrist Surg 2013; 2(2): 126-8. doi: 10.1055/s-0033-1343016. DOI: https://doi.org/10.1055/s-0033-1343016
Tse W L, Lau S W, Wong W Y, Cheng H S, Chow C S, Ho P C, et al. Arthroscopic reconstruction of triangular fibrocartilage complex (TFCC) with tendon graft for chronic DRUJ instability. Injury 2013; 44(3): 386-90. doi: 10.1016/j.injury.2013.01.009. DOI: https://doi.org/10.1016/j.injury.2013.01.009
Edwards S G, Johansen J A. Prospective outcomes and associations of wrist ganglion cysts resected arthroscopically. J Hand Surgery 2009; 34(3): 395-400. doi: 10.1016/j.jhsa.2008.11.025. DOI: https://doi.org/10.1016/j.jhsa.2008.11.025
Fernandes C H, Meirelles L M, Raduan Neto J, Fernandes M, Dos Santos J B G, Faloppa F. Arthroscopic resection of dorsal wrist ganglion: results and rate of recurrence over a minimum follow-up of 4 years. Hand (N Y) 2019; 14(2): 236-41. doi: 10.1177/1558944717743601. DOI: https://doi.org/10.1177/1558944717743601
Fernandes C H, Miranda C D O, dos Santos J B G, Faloppa F. A systematic review of complications and recurrence rate of arthroscopic resection of volar wrist ganglion. Hand Surg 2014; 19(03): 475-80. doi: 10.1142/S0218810414300046. DOI: https://doi.org/10.1142/S0218810414300046
Gallego S, Mathoulin C. Arthroscopic resection of dorsal wrist ganglia: 114 cases with minimum follow-up of 2 years. Arthroscopy 2010; 26(12): 1675-82. doi: 10.1016/j.arthro.2010.05.008. DOI: https://doi.org/10.1016/j.arthro.2010.05.008
Mathoulin C, Hoyos A, Pelaez J. Arthroscopic resection of wrist ganglia. Hand Surg 2004; 9(2): 159-64. doi: 10.1142/s0218810404002169. DOI: https://doi.org/10.1142/S0218810404002169
Mathoulin C, Gras M. Arthroscopic management of dorsal and volar wrist ganglion. Hand Clin 2017; 33(4): 769-77. doi: 10.1016/j.hcl.2017.07.012. DOI: https://doi.org/10.1016/j.hcl.2017.07.012
Rizzo M, Berger R A, Steinmann S P, Bishop A T. Arthroscopic resection in the management of dorsal wrist ganglions: results with a minimum 2-year follow-up period. J Hand Surg Am 2004; 29(1): 59-62. doi: 10.1016/j.jhsa.2003.10.018. DOI: https://doi.org/10.1016/j.jhsa.2003.10.018
Shkolnikova J, Harvey J. Wrist arthroscopy in the management of distal radius fractures. Ann Jt 2018; 3. doi: 10.21037/aoj.2018.08.06. DOI: https://doi.org/10.21037/aoj.2018.08.06
Saito T, Malay S, Chung K C. A systematic review of outcomes after arthroscopic debridement for triangular fibrocartilage complex tear. Plast Reconstr Surg 2017; 140(5): 697e-708e. doi: https://dx.doi.org/10.1097/PRS.0000000000003750. DOI: https://doi.org/10.1097/PRS.0000000000003750
Wartolowska K A, Gerry S, Feakins B G, Collins G S, Cook J, Judge A, et al. A meta-analysis of temporal changes of response in the placebo arm of surgical randomized controlled trials: an update. Trials 2017; 18(1): 323. doi: 10.1186/s13063-017-2070-9. DOI: https://doi.org/10.1186/s13063-017-2070-9
Brignardello-Petersen R, Guyatt G H, Buchbinder R, Poolman R W, Schandelmaier S, Chang Y, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017; 7(5): e016114. doi: 10.1136/bmjopen-2017-016114. DOI: https://doi.org/10.1136/bmjopen-2017-016114
Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, et al. Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear: a 2-year follow-up of the randomised controlled trial. Ann Rheum Dis 2018; 77(2): 188 LP-195. doi: 10.1136/annrheumdis-2017-211172. DOI: https://doi.org/10.1136/annrheumdis-2017-211172
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