RESUMO
Background: Most healthcare providers utilize magnetic resonance imaging (MRI) to assist in diagnosing and treating osteochondritis dissecans (OCD) of the capitellum. However, consensus on imaging features that portend clinically relevant information in the care of these lesions has not been determined. Purpose: To conduct a survey on the MRI features of a capitellar OCD that are salient for clinical decision-making using a classic Delphi protocol. Study Design: A consensus statement. Methods: Invitations to participate were sent to 33 healthcare providers identified as capitellar OCD experts. A classic 3-round survey method was used to gather agreement and consensus on the level of importance for clinical decision-making on 33 MRI features. A concise list of features that guide decision-making on the stability of an OCD lesion and the ability of an OCD lesion to heal with nonoperative care was also identified. Agreement and consensus were determined a priori as ≥66%. Results: Of the 33 identified experts, 20 agreed to participate, and 17 (52%) completed all 3 rounds. Of the 33 MRI features evaluated, 17 reached agreement as important for clinical decision-making by the experts. Consensus was reached for a concise list of MRI features that were significant to decision-making (94%), suggestive of a stable lesion (100%), had the potential to heal with nonoperative treatment (94%), were suggestive of an unstable lesion (100%), and had low potential to heal with nonoperative treatment (88%). Conclusion: This 3-round Delphi process produced consensus on clinically relevant MRI features that contribute to clinical decision-making for capitellar OCD. The results of this study will be used as the basis for an interrater reliability assessment of the identified salient features, creating the foundation for developing a reliable MRI assessment tool rooted in clinical experiences. The development of a standardized assessment of capitellar OCD is intended to improve clinical practice and patient outcomes.
RESUMO
PURPOSE: To prospectively report the outcomes of open carpal tunnel release with respect to patient age and medical comorbidities. METHODS: Nine hundred fifty open carpal tunnel procedures in 826 patients (age range, 21-100 y) at a high-volume orthopedic surgery center were evaluated. Self-reported symptom severity and functional scores were collected using the validated Boston Carpal Tunnel Outcomes questionnaire preoperatively, and at 2 weeks, 6 weeks, and 12 weeks postoperatively. RESULTS: Patients demonstrated a significant improvement in symptom severity scores at 2 weeks and functional severity scores at 6 weeks. Documented patient medical comorbidities did not affect improvement after surgery. Patients with diabetes improved more slowly but were not significantly different at 6 weeks. Patients with workers' compensation insurance were significantly worse at baseline, 2 weeks, and 6 weeks but were not significantly different at 3 months. The risk of negative postoperative endpoints was slightly higher in patients with a medical comorbidity, though not statistically different. CONCLUSIONS: Significant improvements in symptom severity and hand function may be expected after open carpal tunnel release in the general population regardless of age, medical comorbidities, or workers' compensation status. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
