In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot
Julia C A Noorduyn1, M M H Teuwen2,3, V A van de Graaf2,4
1Department of Orthopaedic Surgery, Joint Research, OLVG Amsterdam, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands. j.c.a.noorduyn@olvg.nl.
Summary
Predicting surgery after physical therapy for degenerative meniscal tears is challenging. Prognostic models failed to accurately identify patients who would not benefit from physical therapy, indicating a need for better predictive tools.
Area of Science:
- Orthopedics
- Sports Medicine
- Rehabilitation
Background:
- Physical therapy is the recommended first-line treatment for degenerative meniscal tears in patients over 45.
- However, a significant percentage of these patients still opt for surgery.
- Identifying non-responders to physical therapy is crucial for optimizing treatment pathways.
Purpose of the Study:
- To identify predictors of patients who undergo meniscal surgery after completing physical therapy for a degenerative meniscal tear.
- To develop and validate prognostic models for predicting surgical intervention post-physical therapy.
Main Methods:
- Utilized data from the ESCAPE trial, a randomized clinical trial comparing surgery and physical therapy.
- Developed two multivariable prognostic models using baseline variables and logistic regression.
- Validated models using internal bootstrapping with 500 repetitions.
Main Results:
- At 6 months, 20.9% of patients underwent surgery; predictors included worse knee function, lower education, and better general health.
- At 24 months, 28.1% underwent surgery; predictors included worse knee function and lower education.
- Both models demonstrated low explained variance (16% and 11%) and insufficient predictive accuracy.
Conclusions:
- Not all patients with degenerative meniscal tears achieve positive outcomes with physical therapy alone.
- Current prognostic models cannot accurately predict which patients will not respond to physical therapy and may opt for surgery.
