PurposeTo date, there have been limited studies reporting the mid‐ to long‐term outcomes of meniscoplasties for discoid lateral meniscus. The current study aims to evaluate the mid‐ to long‐term outcomes of arthroscopic meniscoplasty for discoid lateral meniscus in children and adolescents. MethodsIn the study, all patients under the age of 21 years who had undergone arthroscopic meniscoplasty with or without meniscal repair or partial meniscectomy for symptomatic lateral discoid meniscus were included. All patients were then followed up for a minimum of 5 years (median 84 months; range 68–110 months). The Lysholm scores and Ikeuchi scores were collected pre‐operatively and at final follow‐up and were compared. ResultsA total of 24 knees were included in the study. The median duration of follow‐up was 84.0 months (range 68–110 months). The Lysholm score improved from 53 (range 11–95) pre‐operatively to 100.0 (range 60–100) at final follow‐up (p < 0.001). Based on the Ikeuchi score pre‐operatively, 15 knees were rated as poor (62.5%), 7 knees were rated as fair (29.2%), and 2 knees were rated as good (8.4%). The Ikeuchi score improved significantly at the final follow‐up, such that 1 knee was rated as good (4.2%) and 23 knees were rated as excellent (95.8%) (p < 0.001). When analysing the effect of concomitant meniscal repair or partial meniscectomy on the outcomes at final follow‐up, there was no apparent difference in the improvement in Lysholm score or Ikeuchi score when comparing between patients who had meniscoplasty alone and patients who had concomitant meniscal repair, as well as when comparing between patients who had meniscoplasty alone and patients who had concomitant partial meniscectomy. ConclusionMeniscoplasty leads to good mid‐term to long‐term outcomes for children and adolescents with discoid lateral meniscus. Concomitant procedures such as meniscal repair or partial meniscectomy do not improve or worsen the mid‐ to long‐term outcomes in these patients. Level of evidenceIV.

Purpose Patient-reported outcome measures (PROMs) are important measures of success after total knee arthroplasty (TKA) and being able to predict their improvements could enhance preoperative decision-making. Our study aims to compare the predictive performance of machine learning (ML) algorithms and preoperative PROM thresholds in predicting minimal clinically important diference (MCID) attainment at 2 years after TKA. Methods Prospectively collected data of 2840 primary TKA performed between 2008 and 2018 was extracted from our joint replacement registry and split into a training set (80%) and test set (20%). Using the training set, ML algorithms were developed using patient demographics, comorbidities and preoperative PROMs, whereas the optimal preoperative threshold was determined using ROC analysis. Both methods were used to predict MCID attainment for the SF-36 PCS, MCS and WOMAC at 2 years postoperatively, with predictive performance evaluated on the independent test set. Results ML algorithms and preoperative PROM models performed similarly in predicting MCID for the SF-36 PCS (AUC: 0.77 vs 0.74), MCS (AUC: 0.95 vs 0.95) and WOMAC (AUC: 0.89 vs 0.88). For each outcome, the most important predictor of MCID attainment was the patient's preoperative PROM score. ROC analysis also identiied optimal preoperative threshold values of 33.6, 54.1 and 72.7 for the SF-36 PCS, MCS and WOMAC, respectively. Conclusion ML algorithms did not perform signiicantly better than preoperative PROM thresholds in predicting MCID attainment after TKA. Future research should routinely compare the predictive ability of ML algorithms with existing methods and determine the type of clinical problems which may beneit the most from it. Level of evidence II.

Study DesignProspective cohort study.PurposeTo assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied.Overview of LiteratureLiterature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited.MethodsPatients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively.ResultsBoth groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators.ConclusionsAdditional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS.

No abstract

No abstract