Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Pihl, Kenneth; Roos, Ewa M.; Nissen, Nis; Jørgensen, U. G.; Schjerning, Jeppe; Thorlund, Jonas Bloch

doi:10.1080/17453674.2016.1228411

Cited by 43 publications

(34 citation statements)

References 42 publications

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“…30 A second study of arthroscopic meniscus surgery revealed that patients' preoperative expectations were overly optimistic for recovery time and return to leisure activities. 31 These studies provide support for our finding that patients who have previously undergone ipsilateral knee surgery have lower expectations, possibly because they have greater knowledge of knee surgery and experience with the postoperative course of recovery. Similar to our finding that better scores for PROMIS Physical Function, IKDC, pre-injury Tegner Activity Scale, and lower extremity MARX ARS correlate with greater overall expectations or expectations for individual MODEMS domains, Pihl et al determined that patients with better baseline knee function who underwent arthroscopic meniscus surgery had higher expectations.…”

Section: Discussionsupporting

confidence: 62%

“…Similar to our finding that better scores for PROMIS Physical Function, IKDC, pre-injury Tegner Activity Scale, and lower extremity MARX ARS correlate with greater overall expectations or expectations for individual MODEMS domains, Pihl et al determined that patients with better baseline knee function who underwent arthroscopic meniscus surgery had higher expectations. 31 Another study regarding public perception of anterior cruciate ligament surgery found that participants, who likely had high levels of physical function, were highly concerned about returning to activity. 32 Additionally, studies in patients undergoing total knee arthroplasty have shown that the majority of patients expected improvement in daily activities and participation in sports; however, these studies did not consider preoperative knee and physical function.…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Expectations of Patients Undergoing Knee Surgery

et al. 2019

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There is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7–89.3) and median of 91.7 (95% CI, 89.2–94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The Level of Evidence for the study is IV.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Preoperative Expectations of Patients Undergoing Knee Surgery

et al. 2019

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“…This is also the first study to evaluating patients’ expectations and satisfaction of MAT, taking into account prior procedures to the knee. For general meniscal surgery, it has been reported that patients expect fast recovery and a high level of participation in leisure activities [ 15 ]. However, in this study, less than half of the patients were able to participate at the same competition level as they expected preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Meniscal allograft transplantation in The Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions

Wal

Nieuwenhuijse

Spek

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Evaluation of survival of meniscal allograft transplantation (MAT) and postoperative patient-reported outcome (PRO), and their association with prior interventions of the knee. Methods A prospective consecutive study of 109 consecutive patients who had an arthroscopic meniscal allograft transplantation (MAT) between 1999 and 2017 by a single surgeon. Patients were assessed with KOOS scores, preoperative and after a minimal follow-up of 2 years. Furthermore, two anchor questions (whether expectations were met and overall satisfaction, on a five-point Likert scale) were asked. Additionally, prior interventions to MAT were evaluated. Results Prior to MAT, patients had undergone an average of 2.8 (range 1–14) of surgical procedures of the knee. Overall, mean allograft survival was 16.1 years (95% CI 14.8–17.5 years). Higher age at surgery was associated with lower MAT survival: hazard ratio for MAT failure was 1.19 per year increase (95% CI 1.04 to 1.36, p = 0.009). At 4.5 years (IQR, 2–9) of follow-up, all KOOS score were still improved compared to baseline. Age below 35 years, simultaneous anterior cruciate ligament reconstruction and number of knee surgeries before MAT were associated with lower KOOS scores. Overall patient expectations and overall satisfaction after MAT were not associated with preoperative patient characteristics nor with the number or kind of preoperative interventions. Conclusion Meniscal allograft transplantation has a good overall survival with a clinically relevant improvement. Both meniscal allograft survival and PRO were associated with age. PRO was lower in patients younger than 35 years at time of MAT and meniscal allograft survival was worse in patients older than 50 years. PRO was associated with preoperative patient characteristics and number of surgical procedures prior to MAT. All patients reported improved postoperative satisfaction and met expectations after MAT, both independent of the preoperative history of knee interventions. Level of evidence Level III. Trial registration Medical ethical review board (METC) number: 17–104 (7 August 2017). Dutch Trial Register (NTR) number: NTR6630 (4 July 2017).

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“…4 Such surgery results in transient increase in pain and the necessity for restriction in activities for a period of 2–12 weeks. 5 6 Current guidelines recommend against arthroscopic lavage and/or debridement for patients with symptomatic knee osteoarthritis, but do not make specific recommendations for or against partial meniscectomy in those with degenerative meniscal tears (with or without other concomitant degenerative changes). 7 8 Further, many orthopaedic surgeons suggest that patients with mechanical symptoms and meniscal tears—typically locking or catching of the knee—may benefit from arthroscopic partial meniscectomy.…”

Section: Introductionmentioning

confidence: 99%

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review

Brignardello‐Petersen

et al. 2017

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ObjectiveTo determine the effects and complications of arthroscopic surgery compared with conservative management strategies in patients with degenerative knee disease.DesignSystematic review.Main outcome measuresPain, function, adverse events.Data sourcesMEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar and Open Grey up to August 2016.Eligibility criteriaFor effects, randomised clinical trials (RCTs) comparing arthroscopic surgery with a conservative management strategy (including sham surgery) in patients with degenerative knee disease. For complications, RCTs and observational studies.Review methodsTwo reviewers independently extracted data and assessed risk of bias for patient-important outcomes. A parallel guideline committee (BMJ Rapid Recommendations) provided input on the design and interpretation of the systematic review, including selection of patient-important outcomes. We used the GRADE approach to rate the certainty (quality) of the evidence.ResultsWe included 13 RCTs and 12 observational studies. With respect to pain, the review identified high-certainty evidence that knee arthroscopy results in a very small reduction in pain up to 3 months (mean difference =5.4 on a 100-point scale, 95% CI 2.0 to 8.8) and very small or no pain reduction up to 2 years (mean difference =3.1, 95% CI −0.2 to 6.4) when compared with conservative management. With respect to function, the review identified moderate-certainty evidence that knee arthroscopy results in a very small improvement in the short term (mean difference =4.9 on a 100-point scale, 95% CI 1.5 to 8.4) and very small or no improved function up to 2 years (mean difference =3.2, 95% CI −0.5 to 6.8). Alternative presentations of magnitude of effect, and associated sensitivity analyses, were consistent with the findings of the primary analysis. Low-quality evidence suggested a very low probability of serious complications after knee arthroscopy.ConclusionsOver the long term, patients who undergo knee arthroscopy versus those who receive conservative management strategies do not have important benefits in pain or function.Trial registration numberPROSPERO CRD42016046242.

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Over-optimistic patient expectations of recovery and leisure activities after arthroscopic meniscus surgery

Cited by 43 publications

References 42 publications

Preoperative Expectations of Patients Undergoing Knee Surgery

Preoperative Expectations of Patients Undergoing Knee Surgery

Meniscal allograft transplantation in The Netherlands: long-term survival, patient-reported outcomes, and their association with preoperative complaints and interventions

Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review

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