Journal of Hand Surgery - June 2022 - S201

Abstract
S201
Furthermore, conversion to surgery on the longterm
has hardly been described. Therefore, the
objective of this study was to describe the outcomes
of nonsurgical treatment, consisting of exercise
therapy and orthotics, on patient-reported pain and
limitations in activities of daily life (ADL) in patients
with CMC-1 OA after at least 5 years follow-up.
Secondary, we investigated the conversion to surgery
within a follow-up period of at least 5 years and we
explored possible baseline determinants for conversion
to surgery. Other secondary outcomes include
satisfaction with the treatment results and quality of
life (QoL) after at least 5 years follow-up.
Methods: This is a multicenter, prospective cohort
study with observational data investigating outcomes
of an orthosis and exercise therapy using two samples.
The primary outcomes were the Michigan Hand
Outcomes Questionnaire (MHQ) subscales pain and
ADL and were analyzed using linear mixed model
analysis on sample 1, which consists of patients
who met the inclusion and exclusion criteria, who
were not operated and who completed the MHQ at
>5 years. Timepoints included baseline, 3 months,
1 year and >5 years. Conversion to surgery was
extracted from patient records and was analyzed
using a Kaplan Meier survival analysis on sample 2,
which consists of all patients that met the inclusion
and exclusion criteria. Possible baseline determinants
for conversion to surgery were analyzed
using binary logistic regression.
Results: A total of 170 participants were included in
sample 1 and the median follow-up time was 6.6
years (range 5.1-8.7 years). The MHQ subscales
improved with a mean of 17.9 points (p¼<0.0001)
for pain and 13.4 points (p¼<0.0001) for ADL from
baseline to >5 years. Conversion to surgery was
studied of 465 patients in sample 2. We found a conversion
rate of 16.3% after a median follow-up of 7.0
years (range 5.5-9.2 years). Of the baseline variables;
sex, age, symptom duration, pain (MHQ subscale
pain), and limitations in ADL (MHQ subscale ADL),
only pain has an influence (p¼<0.001) on converting
to surgery with an odds ratio of 0.96 (Confidence
Interval 0.94-0.98). Of the 163 participants who completed
the questionnaire about their satisfaction with
the treatment results, 5% responded with 'poor', 14%
with 'moderate', 26% with 'fair', 39% with 'good' and
16% with 'excellent'. Regarding the willingness to
undergo treatment again, 71.2% responded with
'yes'. Concerning the QoL the median EQ-5D-index
is 0.852 (range 0.135-1).
Conclusion: We found clinically relevant improvements
at >5 year follow-up following nonsurgical
treatment of CMC-1 OA. Moreover, only 16% underwent
additional surgical treatment. Our findings
support nonsurgical treatment as a first treatment
option and suggest that treatment effects are sustainable,
although this should be confirmed in a
standardized setting such as a randomized controlled
trial.
A-1153 Return to sport or work following surgical
management of scapholunate interosseous
ligament injury: a systematic review
Mei Yen Liew1, Abigail Semple2, Lewis A Dingle2 and
Philippa A Rust1,3
1University of Edinburgh, Edinburgh, UK
2NHS Lothian, Edinburgh, UK
3Hooper Hand Unit, St John's Hospital, Livingston, UK
Objective: The scapholunate interosseous ligament
(SLIL) is commonly ruptured following a fall onto
the outstretched hand, causing excessive wrist
extension and ulnar deviation. Early diagnosis and
intervention are highly recommended to treat acute
symptoms and prevent progressive degenerative
changes to the wrist. This systematic review aimed
to compare the return rates and times to sport or
work following different surgical managements of
an isolated SLIL injury.
Methods: We conducted a systematic search of
Medline, EMBASE, Cochrane, AMED, CINAHL Plus
and SPORTDiscus to identify primary research
papers assessing the return rates and times to
sport or work following different surgical interventions
for SLIL injury. The keywords used included
'scapholunate', 'scapholunate ligament', 'scaphoid
lunate', 'sport', 'sport injury', 'athlete', 'athletic performance',
'elite', 'return to sport', 'training', 'work',
'activity', 'return to activity' and relevant medical
subject heading (MeSH) terms. All searches were
limited to research papers in the English language.
Two reviewers independently carried out the data
screening according to the PRISMA guidelines and
any discrepancies were resolved by a third reviewer.
The data extracted included the number and demographics
of participants, detailed surgical interventions,
primary outcomes (return rates and times to
sport or work), and secondary outcomes (return
rates to pre-injury level of sport or work and postoperative
complications). The outcomes were statistically
analysed according to the different types of
surgical interventions. Meta-analysis comparisons
were only performed between sufficiently sized
cohorts from the synthesis data for return rates
and times to sport or work using RevMan Version
5.4 (The Cochrane Group). Dichotomous data were
assessed using risk ratios while continuous data
Journal of Hand Surgery - June 2022

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