Thumb MCPJ Collateral Ligament Repair/Reconstruction
Results
Demographics
A total of 18,230 collateral ligament injuries in 18,171 patients were identified during the study period based on the relevant diagnosis codes. 5,700 collateral ligaments in 5,641 patients (31.3% of all injuries) underwent operative treatment. The remaining 68.7% of injuries did not undergo operative treatment.
| Characteristic | Overall, N = 18,1711 | Treatment | p-value2 | |
|---|---|---|---|---|
| Operative, N = 5,6411 | Nonoperative, N = 12,5301 | |||
| Indication | <0.001 | |||
| Sprain | 13,828 (76.1%) | 5,380 (95.4%) | 8,448 (67.4%) | |
| Subluxation | 423 (2.3%) | 66 (1.2%) | 357 (2.8%) | |
| Dislocation | 3,920 (21.6%) | 195 (3.5%) | 3,725 (29.7%) | |
| Age (years) | 35.5 +/- 18.5 | 41.5 +/- 15.7 | 32.8 +/- 19.1 | <0.001 |
| Sex | <0.001 | |||
| Female | 7,576 (41.7%) | 2,467 (43.7%) | 5,109 (40.8%) | |
| Male | 10,595 (58.3%) | 3,174 (56.3%) | 7,421 (59.2%) | |
| Race | <0.001 | |||
| White | 10,187 (56.2%) | 3,662 (64.9%) | 6,525 (52.3%) | |
| Black | 3,033 (16.7%) | 588 (10.4%) | 2,445 (19.6%) | |
| Hispanic | 2,056 (11.3%) | 362 (6.4%) | 1,694 (13.6%) | |
| Asian | 397 (2.2%) | 124 (2.2%) | 273 (2.2%) | |
| Native American | 71 (0.4%) | 16 (0.3%) | 55 (0.4%) | |
| Other or Unknown | 2,378 (13.1%) | 889 (15.8%) | 1,489 (11.9%) | |
| Elixhauser score | 0.1 +/- 1.2 | 0.1 +/- 1.3 | 0.1 +/- 1.1 | 0.003 |
| Insurance | <0.001 | |||
| Private | 11,377 (62.6%) | 4,106 (72.8%) | 7,271 (58.1%) | |
| Medicare | 1,292 (7.1%) | 351 (6.2%) | 941 (7.5%) | |
| Medicaid | 2,195 (12.1%) | 262 (4.6%) | 1,933 (15.4%) | |
| Worker's Compensation | 1,723 (9.5%) | 722 (12.8%) | 1,001 (8.0%) | |
| Other | 1,579 (8.7%) | 200 (3.5%) | 1,379 (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
-0.025534 -0.016297 -0.005817 0.013044 0.040761
Coefficients:
Estimate Std. Error t value Pr(>|t|)
(Intercept) -17.534909 4.478339 -3.915 0.00354 **
disch_yr 0.008860 0.002222 3.987 0.00317 **
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Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
Residual standard error: 0.02331 on 9 degrees of freedom
Multiple R-squared: 0.6384, Adjusted R-squared: 0.5983
F-statistic: 15.89 on 1 and 9 DF, p-value: 0.003174Analysis 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 0.0048901
2 8 0.0048852 1 0.00000488 0.0380 0.853191
3 7 0.0021823 1 0.00270289 21.0046 0.005931 **
4 6 0.0006550 1 0.00152732 11.8690 0.018333 *
5 5 0.0006434 1 0.00001160 0.0902 0.776051
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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 25.7% in 2011 and a maximum of 35.8% 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
| Characteristic | Univariable | Multivariable | ||||
|---|---|---|---|---|---|---|
| OR1 | 95% CI1 | p-value | OR1 | 95% CI1 | p-value | |
| Insurance | ||||||
| Medicaid | — | — | — | — | ||
| Private | 4.15 | 3.64, 4.75 | <0.001 | 3.23 | 2.82, 3.71 | <0.001 |
| Worker's Compensation | 5.28 | 4.50, 6.20 | <0.001 | 3.55 | 3.01, 4.19 | <0.001 |
| Medicare | 2.73 | 2.28, 3.26 | <0.001 | 0.75 | 0.61, 0.91 | 0.004 |
| Other | 1.06 | 0.87, 1.29 | 0.565 | 0.93 | 0.76, 1.14 | 0.485 |
| Age (Years) | 1.03 | 1.03, 1.03 | <0.001 | |||
| Sex | ||||||
| Female | — | — | ||||
| Male | 1.09 | 1.02, 1.17 | 0.012 | |||
| Race | ||||||
| White | — | — | ||||
| Black | 0.52 | 0.47, 0.58 | <0.001 | |||
| Hispanic | 0.45 | 0.40, 0.51 | <0.001 | |||
| Asian | 0.90 | 0.72, 1.13 | 0.366 | |||
| Native American | 0.62 | 0.34, 1.08 | 0.104 | |||
| Other or Unknown | 1.12 | 1.01, 1.23 | 0.027 | |||
| 1 OR = Odds Ratio, CI = Confidence Interval | ||||||
Survival analysis
Among all patients treated operatively, 43 operatively treated injuries (0.8%) eventually failed primary operative treatment and required MCPJ arthrodesis. The mean time from primary surgery to arthrodesis was 1.1 +/- 0.9 years.
