Thumb MCPJ Collateral Ligament Repair/Reconstruction
Results
Demographics
A total of 19,046 collateral ligament injuries in 18,918 patients were identified during the study period based on the relevant diagnosis codes. 6,439 collateral ligaments in 6,311 patients (33.8% of all injuries) underwent operative treatment. The remaining 66.2% of injuries did not undergo operative treatment.
| Characteristic | Overall, N = 18,9181 | Treatment | p-value2 | |
|---|---|---|---|---|
| Operative, N = 6,3111 | Nonoperative, N = 12,6071 | |||
| Indication | <0.001 | |||
| Sprain | 14,576 (77.0%) | 6,051 (95.9%) | 8,525 (67.6%) | |
| Subluxation | 423 (2.2%) | 66 (1.0%) | 357 (2.8%) | |
| Dislocation | 3,919 (20.7%) | 194 (3.1%) | 3,725 (29.5%) | |
| Age (years) | 35.8 +/- 18.5 | 41.5 +/- 15.7 | 32.9 +/- 19.1 | <0.001 |
| Sex | <0.001 | |||
| Female | 7,916 (41.8%) | 2,781 (44.1%) | 5,135 (40.7%) | |
| Male | 11,002 (58.2%) | 3,530 (55.9%) | 7,472 (59.3%) | |
| Race | <0.001 | |||
| White | 10,614 (56.3%) | 4,065 (64.4%) | 6,549 (52.2%) | |
| Black | 3,123 (16.6%) | 665 (10.5%) | 2,458 (19.6%) | |
| Hispanic | 2,121 (11.2%) | 419 (6.6%) | 1,702 (13.6%) | |
| Asian | 428 (2.3%) | 152 (2.4%) | 276 (2.2%) | |
| Native American | 74 (0.4%) | 18 (0.3%) | 56 (0.4%) | |
| Other or Unknown | 2,509 (13.3%) | 992 (15.7%) | 1,517 (12.1%) | |
| Elixhauser score | 0.1 +/- 1.2 | 0.1 +/- 1.3 | 0.1 +/- 1.1 | 0.003 |
| Insurance | <0.001 | |||
| Private | 11,897 (62.9%) | 4,572 (72.4%) | 7,325 (58.1%) | |
| Medicare | 1,348 (7.1%) | 401 (6.4%) | 947 (7.5%) | |
| Medicaid | 2,255 (11.9%) | 313 (5.0%) | 1,942 (15.4%) | |
| Worker's Compensation | 1,809 (9.6%) | 803 (12.7%) | 1,006 (8.0%) | |
| Other | 1,604 (8.5%) | 222 (3.5%) | 1,382 (11.0%) | |
| 1 n (%); Mean +/- SD | ||||
| 2 Pearson’s Chi-squared test; Welch Two Sample t-test | ||||
Operative versus nonoperative treatment
Call:
lm(formula = perc ~ disch_yr, data = perc_operative)
Residuals:
Min 1Q Median 3Q Max
-0.02643 -0.01868 -0.00941 0.02011 0.03829
Coefficients:
Estimate Std. Error t value Pr(>|t|)
(Intercept) -24.891895 5.066219 -4.913 0.000832 ***
disch_yr 0.012524 0.002514 4.981 0.000758 ***
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Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
Residual standard error: 0.02637 on 9 degrees of freedom
Multiple R-squared: 0.7338, Adjusted R-squared: 0.7043
F-statistic: 24.81 on 1 and 9 DF, p-value: 0.0007582Analysis of Variance Table
Model 1: perc ~ disch_yr
Model 2: perc ~ poly(disch_yr, 2)
Model 3: perc ~ poly(disch_yr, 3)
Model 4: perc ~ poly(disch_yr, 4)
Model 5: perc ~ poly(disch_yr, 5)
Res.Df RSS Df Sum of Sq F Pr(>F)
1 9 0.0062582
2 8 0.0062555 1 0.0000028 0.0119 0.91728
3 7 0.0026193 1 0.0036361 15.6209 0.01083 *
4 6 0.0014640 1 0.0011553 4.9633 0.07637 .
5 5 0.0011639 1 0.0003001 1.2894 0.30765
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Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
The percentage of injuries treated operatively increased over the study period, with a minimum of 27.3% in 2011 and a maximum of 40.1% in 2017. The percentage of operative cases appears to increase steadily until 2016 before leveling off. Based on a linear approximation, there was a significant increase of 1.3% per year in the percentage of injuries treated operatively. In Figure 2, the blue curve represents the linear approximation, while the red curve represents a cubic polynomial fit to the percentage of injuries treated operatively over time, which more accurately describes the data.
Demographic factors affecting operative treatment
Table 1: Odds of operative treatment. A is uncontrolled effect of insurance. B is effect of insurance controlling for covariates.
| Characteristic | OR1 | 95% CI1 | p-value |
|---|---|---|---|
| Insurance | |||
| Medicaid | — | — | |
| Private | 3.86 | 3.42, 4.38 | <0.001 |
| Worker's Compensation | 4.96 | 4.27, 5.77 | <0.001 |
| Medicare | 2.63 | 2.23, 3.10 | <0.001 |
| Other | 0.98 | 0.82, 1.18 | 0.861 |
| 1 OR = Odds Ratio, CI = Confidence Interval | |||
| Characteristic | OR1 | 95% CI1 | p-value |
|---|---|---|---|
| Insurance | |||
| Medicaid | — | — | |
| Private | 3.00 | 2.65, 3.42 | <0.001 |
| Worker's Compensation | 3.35 | 2.87, 3.91 | <0.001 |
| Medicare | 0.72 | 0.60, 0.87 | <0.001 |
| Other | 0.87 | 0.72, 1.05 | 0.137 |
| Age (Years) | 1.03 | 1.03, 1.03 | <0.001 |
| Sex | |||
| Female | — | — | |
| Male | 1.07 | 1.01, 1.15 | 0.033 |
| Race | |||
| White | — | — | |
| Black | 0.54 | 0.49, 0.59 | <0.001 |
| Hispanic | 0.47 | 0.42, 0.53 | <0.001 |
| Asian | 0.99 | 0.80, 1.22 | 0.909 |
| Native American | 0.61 | 0.34, 1.04 | 0.079 |
| Other or Unknown | 1.09 | 1.00, 1.20 | 0.059 |
| 1 OR = Odds Ratio, CI = Confidence Interval | |||
Survival analysis
Among all patients treated operatively, 57 operatively treated injuries (0.9%) eventually failed primary operative treatment and required MCPJ arthrodesis. The mean time from primary surgery to arthrodesis was 1.1 +/- 0.9 years.
