Alexander W Aleem1, Justin D Krogue1, Ryan P Calfee2. 1. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO. 2. Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: calfeer@wudosis.wustl.edu.
Abstract
PURPOSE: To compare both validated patient-rated and objective outcomes of patients following revision cubital tunnel surgery to a similar group of patients who underwent primary surgery. METHODS: This case-control investigation enrolled 56 patients treated surgically for cubital tunnel syndrome (28 revision cases, 28 primary controls) at a tertiary center. Patients with a minimum of 2 years of follow-up were eligible. All patients completed an in-office study evaluation. Revision participants represented 55% of potential patients in our practice and controls (treated only with primary surgery) were chosen at random from our practice to reach a 1:1 case to control ratio. Preoperative McGowan grading was confirmed similar between the groups. Outcome measures included validated patient outcome questionnaires (Patient-Rated Elbow Evaluation, Levine-Katz questionnaire), symptoms, and physical examination findings. Statistical analyses were conducted to compare the patient groups. RESULTS: Despite 79% of revision patients reporting symptomatic improvement, revision patients reported worse outcomes on all measured standardized questionnaires compared with primary patients. The Levine-Katz questionnaire indicated mild residual symptoms in the primary group (1.6) versus moderate remaining symptoms following revision surgery (2.3). The Patient-Rated Elbow Evaluation also indicated superior results for the control group (9 ± 10) compared with the revision group (32 ± 22). Revision patients had a higher frequency of constant symptoms, elevated 2-point discrimination, and diminished pinch strength. McGowan grading improved after 25% of revision surgeries versus 64% of primary surgeries, and 21% of revision patients had deterioration of their McGowan grade. CONCLUSIONS: Subjective and objective outcomes of revision patients in this cohort were inferior to outcomes of similar patients following primary surgery. Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained by an alternative diagnosis, but patients should be counseled that complete resolution of symptoms is unlikely. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
PURPOSE: To compare both validated patient-rated and objective outcomes of patients following revision cubital tunnel surgery to a similar group of patients who underwent primary surgery. METHODS: This case-control investigation enrolled 56 patients treated surgically for cubital tunnel syndrome (28 revision cases, 28 primary controls) at a tertiary center. Patients with a minimum of 2 years of follow-up were eligible. All patients completed an in-office study evaluation. Revision participants represented 55% of potential patients in our practice and controls (treated only with primary surgery) were chosen at random from our practice to reach a 1:1 case to control ratio. Preoperative McGowan grading was confirmed similar between the groups. Outcome measures included validated patient outcome questionnaires (Patient-Rated Elbow Evaluation, Levine-Katz questionnaire), symptoms, and physical examination findings. Statistical analyses were conducted to compare the patient groups. RESULTS: Despite 79% of revision patients reporting symptomatic improvement, revision patients reported worse outcomes on all measured standardized questionnaires compared with primary patients. The Levine-Katz questionnaire indicated mild residual symptoms in the primary group (1.6) versus moderate remaining symptoms following revision surgery (2.3). The Patient-Rated Elbow Evaluation also indicated superior results for the control group (9 ± 10) compared with the revision group (32 ± 22). Revision patients had a higher frequency of constant symptoms, elevated 2-point discrimination, and diminished pinch strength. McGowan grading improved after 25% of revision surgeries versus 64% of primary surgeries, and 21% of revision patients had deterioration of their McGowan grade. CONCLUSIONS: Subjective and objective outcomes of revision patients in this cohort were inferior to outcomes of similar patients following primary surgery. Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained by an alternative diagnosis, but patients should be counseled that complete resolution of symptoms is unlikely. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
Authors: Christopher L Camp; Collin C Tebo; Ryan M Degen; Joshua S Dines; David W Altchek; Brian C Werner Journal: Orthop J Sports Med Date: 2018-05-15