Internvention RCTs Involving Wrist and Shoulder Arthroscopy
Although arthroscopy of upper extremity joints was initially introduced mainly for diagnostic purposes it is being increasingly used for therapeutic interventions. For example, wrist interventions performed through arthroscopy include, among others, excision of wrist ganglia, treatment of acute fractures and of non-unions, ligament repair and reconstructions, repair or debridement of the triangular fibrocartilage complex, ulnar head resection, partial or total removal of carpal bones, and joint fusions. A recent study on musculoskeletal upper extremity ambulatory surgery in the United States estimated that 272,148 rotator cuff repairs, 257,541 shoulder arthroscopies excluding those for cuff repairs, 3686 elbow arthroscopies, and 25,250 wrist arthroscopies were performed in 2006. Arthroscopic interventions generally require special equipment and substantial surgical training and may thus be associated with higher costs than open procedures. In addition, arthroscopic procedures may be associated with various complications. Arthroscopic interventions may, however, be more cost-effective if their efficacy is superior to that of non-arthroscopic treatments or if they have similar efficacy but provide additional benefit, such as quicker recovery or lower morbidity. There is strong agreement that good-quality randomized controlled trials (RCTs) are the gold standard for assessing treatment efficacy and that they provide higher level of evidence than observational studies. We reviewed the literature for intervention RCTs involving wrist arthroscopy, and for comparison, shoulder arthroscopy, hypothesizing that the quality of wrist and shoulder RCTs are similar.
Background
Although arthroscopy of upper extremity joints was initially introduced mainly for diagnostic purposes it is being increasingly used for therapeutic interventions. For example, wrist interventions performed through arthroscopy include, among others, excision of wrist ganglia, treatment of acute fractures and of non-unions, ligament repair and reconstructions, repair or debridement of the triangular fibrocartilage complex, ulnar head resection, partial or total removal of carpal bones, and joint fusions. A recent study on musculoskeletal upper extremity ambulatory surgery in the United States estimated that 272,148 rotator cuff repairs, 257,541 shoulder arthroscopies excluding those for cuff repairs, 3686 elbow arthroscopies, and 25,250 wrist arthroscopies were performed in 2006. Arthroscopic interventions generally require special equipment and substantial surgical training and may thus be associated with higher costs than open procedures. In addition, arthroscopic procedures may be associated with various complications. Arthroscopic interventions may, however, be more cost-effective if their efficacy is superior to that of non-arthroscopic treatments or if they have similar efficacy but provide additional benefit, such as quicker recovery or lower morbidity. There is strong agreement that good-quality randomized controlled trials (RCTs) are the gold standard for assessing treatment efficacy and that they provide higher level of evidence than observational studies. We reviewed the literature for intervention RCTs involving wrist arthroscopy, and for comparison, shoulder arthroscopy, hypothesizing that the quality of wrist and shoulder RCTs are similar.
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