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Establishing the Minimal Clinically Important Difference and Patient-Acceptable Symptomatic State After Arthroscopic
Bhargavi Maheshwer1, Stephanie E Wong2, Evan M Polce3
1University of Cincinnati College of Medicine, Cincinnati, OH, U.S.A.
Purpose:
To establish the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) after arthroscopic meniscal repair and identify the factors associated with achieving these outcomes.
Methods:
This is a retrospective study with prospectively collected data. Patient-reported outcome measures (PROMs) were collected from April 2017 to March 2020. All patients who underwent arthroscopic meniscal repair and completed both preoperative and postoperative PROMs were included in the analysis. MCID and PASS were calculated via half the standard deviation of the delta PRO change from baseline (for International Knee Documentation Committee Score [IKDC]) and via anchor-based methodology (Knee Injury and Osteoarthritis Outcome Score [KOOS] subscales).
Results:
Sixty patients were included in the final analysis. The established MCID threshold values were 10.9 for IKDC, 12.3 for KOOS Symptoms, 11.8 for KOOS Pain, 11.4 for KOOS Activities of Daily Living (ADL), 16.7 for KOOS Sport, and 16.9 for KOOS Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 69.0 for IKDC, 75.0 for KOOS Symptoms, 80.6 for KOOS Pain, 92.7 for KOOS ADL, 80.0 for KOOS Sport, and 56.3 for KOOS QoL. Higher preoperative PRO scores were associated with lower likelihood of achieving MCID. Concomitant ligament procedures were associated with a higher likelihood of achieving PASS. Tears to both menisci were associated with decreased likelihood of achieving MCID and PASS for IKDC. Horizontal tears were associated with decreased likelihood of achieving PASS for IKDC and KOOS. Complex tears were associated with decreased likelihood of achieving MCID for KOOS.
Conclusion:
Clinically meaningful outcomes such as MCID and PASS were established for meniscal repair surgery using selected PROMs for IKDC and KOOS subscales. Variables more likely to be associated with achieving these outcomes include lower preoperative PRO score and concomitant ligament procedure, whereas higher preoperative PRO score, tearing of both medial and lateral menisci, and horizontal and complex tear classifications were associated with decreased likelihood of achieving these outcomes.
Level Of Evidence:
IV, retrospective case series.
Insights
This study establishes the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) after arthroscopic meniscal repair. Lower preoperative scores and ligament procedures improve outcomes, while complex tears may hinder them.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Rehabilitation Science
Background:
- Arthroscopic meniscal repair aims to restore knee function and alleviate pain.
- Establishing benchmarks for clinical improvement is crucial for evaluating surgical success and patient satisfaction.
Purpose of the Study:
- To determine the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) following arthroscopic meniscal repair.
- To identify factors influencing the achievement of MCID and PASS after this procedure.
Main Methods:
- Retrospective analysis of prospectively collected patient-reported outcome measures (PROMs) from April 2017 to March 2020.
- Calculation of MCID and PASS using standard deviation of change and anchor-based methods for IKDC and KOOS subscales.
- Inclusion of patients who underwent arthroscopic meniscal repair and completed pre- and postoperative PROMs.
Main Results:
- Established MCID thresholds for IKDC and KOOS subscales (e.g., IKDC: 10.9, KOOS Symptoms: 12.3).
- Defined PASS thresholds for IKDC and KOOS subscales (e.g., IKDC: 69.0, KOOS Symptoms: 75.0).
- Identified factors associated with outcomes: lower preoperative PROs and concomitant ligament procedures favored better outcomes, while bilateral meniscal tears and complex/horizontal tears were associated with poorer outcomes.
Conclusions:
- Defined clinically meaningful outcome metrics (MCID and PASS) for arthroscopic meniscal repair using IKDC and KOOS.
- Lower preoperative scores and concomitant ligament procedures are associated with achieving better outcomes.
- Bilateral meniscal tears, horizontal, and complex tears are associated with a decreased likelihood of achieving MCID and PASS.
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