Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis
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 predi...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-12-01
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| Series: | Arthroscopy, Sports Medicine, and Rehabilitation |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666061X20300675 |
| _version_ | 1819069599796166656 |
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| author | Alexander Beletsky, B.A. Anirudh K. Gowd, M.D. Joseph N. Liu, M.D. Brandon J. Manderle, M.D. Adam B. Yanke, M.D. Brian Forsythe, M.D. Brian J. Cole, M.D. Nikhil Verma, M.D. |
| author_facet | Alexander Beletsky, B.A. Anirudh K. Gowd, M.D. Joseph N. Liu, M.D. Brandon J. Manderle, M.D. Adam B. Yanke, M.D. Brian Forsythe, M.D. Brian J. Cole, M.D. Nikhil Verma, M.D. |
| author_sort | Alexander Beletsky, B.A. |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T16:52:37Z |
| format | Article |
| id | doaj.art-66a3fb987add47a28aa7ec58be40fb2e |
| institution | Directory Open Access Journal |
| issn | 2666-061X |
| language | English |
| last_indexed | 2024-12-21T16:52:37Z |
| publishDate | 2020-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroscopy, Sports Medicine, and Rehabilitation |
| spelling | doaj.art-66a3fb987add47a28aa7ec58be40fb2e2022-12-21T18:56:50ZengElsevierArthroscopy, Sports Medicine, and Rehabilitation2666-061X2020-12-0126e723e733Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate AnalysisAlexander Beletsky, B.A.0Anirudh K. Gowd, M.D.1Joseph N. Liu, M.D.2Brandon J. Manderle, M.D.3Adam B. Yanke, M.D.4Brian Forsythe, M.D.5Brian J. Cole, M.D.6Nikhil Verma, M.D.7Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.Department of Orthopedic Surgery, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.; Address correspondence to Nikhil N. Verma, M.D., Midwest Orthopaedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, 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.http://www.sciencedirect.com/science/article/pii/S2666061X20300675 |
| spellingShingle | Alexander Beletsky, B.A. Anirudh K. Gowd, M.D. Joseph N. Liu, M.D. Brandon J. Manderle, M.D. Adam B. Yanke, M.D. Brian Forsythe, M.D. Brian J. Cole, M.D. Nikhil Verma, M.D. Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis Arthroscopy, Sports Medicine, and Rehabilitation |
| title | Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis |
| title_full | Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis |
| title_fullStr | Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis |
| title_full_unstemmed | Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis |
| title_short | Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis |
| title_sort | time to achievement of clinically significant outcomes after isolated arthroscopic partial meniscectomy a multivariate analysis |
| url | http://www.sciencedirect.com/science/article/pii/S2666061X20300675 |
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