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Resolution of Pain at Night and Improved Functional Outcomes After Arthroscopic Partial Meniscectomy
Evan T Zheng1, Koya Osada2, Jillian L Mazzocca3
1Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA.
Background:
Arthroscopic partial meniscectomy (APM) is performed for symptomatic meniscal tears that fail conservative treatment. Patients often report pain at night, although little research has been done to evaluate corresponding outcomes.
Purpose:
To (1) evaluate patients with and without preoperative nighttime pain who underwent APM and (2) assess postoperative resolution of symptoms and associated patient-reported outcome measures (PROMs).
Study Design:
Case series; Level of evidence, 4.
Methods:
Consecutive patients undergoing primary APM with or without chondroplasty at a tertiary academic center were prospectively enrolled in a database. Patient characteristics and PROMs were obtained pre- and postoperatively up to 2 years-including the visual analog pain scale, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Scale, and Veterans RAND 12-Item Health Survey (VR-12) physical and mental components. Patients were included if they had a minimum 3-month PROMs follow-up. Pain at night was defined as reporting greater than mild pain on KOOS P7. Intraoperatively, cartilage was assessed using the Outerbridge Classification.
Results:
A total of 587 patients were included, with 299 (50.9%) reporting preoperative pain at night, which corresponded with worse baseline PROMs. These patients were older and more likely to be women and smokers. No significant difference was observed in Outerbridge grade between patients with and without preoperative pain at night. Postoperatively, nighttime pain resolved by 2 years in 274 (91.6%) patients, 219 of whom (79.9%) reported improvement by 3 months. Patients whose pain at night persisted had a longer duration of symptoms preoperatively, higher body mass index, and a lack of baseline mechanical symptoms. PROMs significantly improved for patients with and without preoperative pain at night, although patients with baseline pain had worse scores compared with those without preoperative nighttime pain.
Conclusion:
Over half of patients undergoing APM reported preoperative pain at night, which was associated with worse baseline functional scores. Postoperatively, >90% of patients with baseline pain at night noted resolution of symptoms by 2 years, with nearly 80% showing improvement by 3 months. Functional scores improved after surgery for patients with and without initial pain at night, remaining lower for patients who had preoperative nighttime pain.
