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Surgical decision making for arthroscopic partial meniscectomy in patients aged over 40 years
Stephen Lyman1, Luke S Oh, Keith R Reinhardt
1Hospital for Special Surgery, New York, New York 10021, USA. LymanS@hss.edu
Purpose:
To identify clinical variables that affect a surgeon's decision to recommend arthroscopic partial meniscectomy (APM).
Methods:
Members of 2 orthopaedic specialty societies were invited to participate in an online survey by e-mail. The survey consisted of surgeon demographics and case scenarios to evaluate clinical decision making for APM. Posterior probabilities were calculated to determine the effect of clinical factors on the likelihood of recommending APM.
Results:
Of the respondents with valid e-mail addresses, 733 (19.3%) returned a completed survey, but only 533 (14.1%) met the eligibility criteria (treated or referred an APM candidate within the past year). Respondents were aged 46.7 ± 9.4 and had performed a mean of 115 APMs in the previous year. Posterior probabilities for a combination of 6 clinical indicators identified 3 factors that most influenced a surgeon's decision to recommend APM: radiographic findings, McMurray test, and failure of nonoperative management.
Conclusions:
Significant variation exists among practicing orthopaedic surgeons with regard to decision making for APM. The 3 clinical factors that most influenced a surgeon's decision to recommend APM were normal radiographic findings, failed nonoperative treatment, and the presence of positive physical examination findings (i.e., positive McMurray test, joint line tenderness, and effusion).
Level Of Evidence:
Level III, decision analysis.