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Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A
Alexander Beletsky1, Anirudh K Gowd1, Joseph N Liu2
1Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.
Purpose:
To define the time required to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) for isolated arthroscopic partial meniscectomy (APM), and define preoperative and intraoperative factors that predict both early and late achievement of the stated metrics.
Methods:
Patients who underwent isolated APM between 2014 and 2017 were retrospectively included. Patients without preoperative and 6-month patient-reported outcome measure scores, revision procedures, and significant concomitant procedures were excluded. The MCID, SCB, and PASS were calculated for knee-based patient-reported outcome measure scores using receiver operating curve analysis. Kaplan-Meier survival analysis established the time required to achieve MCID, SCB and PASS. Hazard ratios from multivariate Cox regression allowed for the isolation of demographic and intraoperative factors predictive of the delayed time required to achieve MCID, SCB and PASS.
Results:
A total of 126 patients (42.86% female, age: 48.9 ± 12.4 years) were included. Overall achievement rates ranged between 73.0% and 89.7% for MCID, 43.7% and 68.2% for SCB, and 50.8% and 68.3% for PASS. Median achievement time for MCID was 5.68-5.78 months, 5.73-6.05 months for SCB and 6.54-7.72 months for PASS. Multivariate Cox regression identified older age, workers' compensation status, diabetes, and various tear types (i.e., longitudinal, transverse, bucket handle, complex) as predictors of early clinically significant outcome achievement (hazard ratio: 1.02-24.72), whereas subsequent steroid injection, higher preoperative scores and root and flap tears predicted delays in clinically significant outcome achievement (hazard ratio: 0.12-0.99).
Conclusions:
The majority of patients undergoing APM achieve benefit within 6 months of surgery, with diminishing proportions at later timepoints. Important factors for consideration of the the timeline of achieving clinically significant outcome include age, diabetes, workers' compensation, preoperative score, and tear type. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving APM.
Study Design:
Level IV, Therapeutic Case Series.
Insights
Most patients achieve meaningful improvement after arthroscopic partial meniscectomy (APM) within six months. Factors like age, diabetes, and tear type influence the timeline for recovery and achieving patient acceptable symptomatic state (PASS).
Area of Science:
- Orthopedic surgery
- Sports medicine
- Knee reconstruction
Background:
- Arthroscopic partial meniscectomy (APM) is a common procedure for meniscal tears.
- Understanding the timeline for patient recovery and satisfaction is crucial for managing expectations and optimizing outcomes.
- Key metrics for success include minimally clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS).
Purpose of the Study:
- To determine the time required to achieve MCID, SCB, and PASS following isolated APM.
- To identify preoperative and intraoperative factors that predict early or delayed achievement of these outcome metrics.
Main Methods:
- Retrospective analysis of 126 patients who underwent isolated APM between 2014 and 2017.
- Calculation of MCID, SCB, and PASS using receiver operating curve analysis on patient-reported outcome measures.
- Kaplan-Meier survival analysis and multivariate Cox regression to assess time to achievement and predictive factors.
Main Results:
- The majority of patients achieved MCID (73.0%-89.7%), SCB (43.7%-68.2%), and PASS (50.8%-68.3%).
- Median achievement times were approximately 5.7 months for MCID, 6.0 months for SCB, and 7.7 months for PASS.
- Older age, workers' compensation, diabetes, and complex tear types predicted early achievement, while steroid injections and higher preoperative scores predicted delays.
Conclusions:
- Most patients experience significant benefit from APM within six months post-surgery.
- Patient age, comorbidities (diabetes), insurance status (workers' compensation), preoperative knee function, and specific meniscal tear characteristics influence recovery timelines.
- These findings can help set realistic patient expectations and inform future research on APM outcomes.
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