Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts

Wang, Dean; Chang, Brenda; Coxe, Francesca R.; Pais, Mollyann D.; Wickiewicz, Thomas L.; Warren, Russell F.; Rodeo, Scott A.; Williams, Riley J.

doi:10.1177/0363546518808030

Cited by 37 publications

(52 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is imperative to consider that thresholds for clinically significant improvements vary by both population and disease, suggesting the importance of defining microfracture-specific psychometric measures. The threshold values defined by this study are similar to those of other studies that have defined clinically significant outcome thresholds for other cartilage preservation procedures, 6,24 thus reinforcing the appropriateness of the current analysis. Future research will need to validate the use of these psychometric thresholds and further define them at longer follow-up time points.…”

Section: Discussionsupporting

confidence: 81%

“…1,8 To better understand the clinical effect of the microfracture procedure, it is important to define clinically meaningful outcome measures such as the MCID and PASS to distinguish between statistically significant and clinically significant outcomes. Although clinically significant outcome thresholds have been established for other cartilage preservation procedures of the knee, such as osteochondral allograft transfer, 17 fresh osteochondral allograft transplant, 24 and autologous chondrocyte implant, 16 such thresholds have not been established specifically for microfracture.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Defining the Minimal Clinically Important Difference and Patient Acceptable Symptom State for Microfracture of the Knee: A Psychometric Analysis at Short-term Follow-up

et al. 2020

View full text Add to dashboard Cite

Background: Several studies have investigated failure rates and magnitude of improvement in patient-reported outcome measures after microfracture surgery for focal chondral defects of the knee; however; what constitutes clinically significant improvement in this patient population is poorly understood. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for microfracture surgery including the time-dependent nature of these thresholds and (2) identify predictors of achieving the MCID and PASS in patients specifically undergoing microfracture of the knee. Study Design: Case series; Level of evidence, 4. Methods: A secure institutional cartilage preservation repository was queried for all patients who underwent microfracture between 2004 and 2017. The distribution method was used to calculate MCID thresholds for the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), whereas an anchor-based method was used for the PASS. Multivariate logistic regressions were constructed to determine predictors of achieving the MCID and PASS. Results: A total of 206 patients with a mean ± SD age of 33.7 ± 13.2 years and body mass index of 26.9 ± 5.3 kg/m2 were included. All thresholds for the MCID and PASS increased over time except for the MCID thresholds for the KOOS Sports and Symptoms subscales. The proportion of patients who achieved the MCID (6 months, 78.4%; 12 months, 83.9%; 24 months, 88.6%) and PASS (6 months, 67.7%; 12 months, 79.2%; 24 months, 76.1%) generally increased over time. Older age and larger lesion size were negative independent predictors of MCID achievement. Older age was also a negative predictor of the PASS, whereas male sex and higher preoperative KOOS Symptoms and Pain scores were positive independent predictors of the PASS. Conclusion: The MCID and PASS thresholds for the IKDC and KOOS in patients undergoing microfracture of the knee are dynamic, with an increasing number of patients achieving the MCID over time. The percentage achieving the PASS increased between 6 and 12 months and then declined slightly at 24 months. Independent predictors of achieving the MCID were lesion size and age at surgery, whereas predictors of achieving the PASS included lesion size, male sex, and greater preoperative KOOS Symptoms and Pain scores.

show abstract

Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Defining the Minimal Clinically Important Difference and Patient Acceptable Symptom State for Microfracture of the Knee: A Psychometric Analysis at Short-term Follow-up

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Limitations of that study were that a distribution-based approach was used to calculate the MCID and the sample size for the PASS data was only 34 patients. Wang et al 19 conducted a 2-year prospective follow-up study to determine MCID and substantial clinical benefit (SCB) estimates for the IKDC and Knee Outcome Score Activities of Daily Living scale among patients treated using either osteochondral autograft or allograft transplant. The strengths of this study were the large sample size (n = 173), the use of an anchor-based approach, and optimized internal validity because of the focus on a particular surgical technique.…”

Section: Discussionmentioning

confidence: 99%

The Clinically Important Difference and Patient Acceptable Symptomatic State for Commonly Used Patient-Reported Outcomes After Knee Cartilage Repair

et al. 2020

View full text Add to dashboard Cite

Background: In patients undergoing cartilage restoration of the knee, limited information is available regarding clinically important difference (CID) and Patient Acceptable Symptomatic State (PASS) estimates for commonly used patient-reported outcome measures (PROMs). Purpose: The objective of this study was to determine the CID and PASS in the population with knee cartilage restoration for the Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee Subjective Knee Form (IKDC) score, and the Lysholm score. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between 2012 and 2017, patients who underwent a cartilage restoration procedure were prospectively enrolled. Patients completed the KOOS, IKDC, and Lysholm, all of which were scored from 0 to 100, and completed relevant anchor questions at baseline and 1 year postoperatively. Receiver operating characteristic curve analyses were conducted to determine CID and PASS cutoff points. Multivariable regression analyses were performed to determine the effect of age, sex, and baseline score on likelihood of achieving CID and PASS. Results: Of the 113 patients enrolled, 53 (47%) were male, and the mean age was 36 years. The CID values for the PROMs were 10.7 for KOOS Symptoms, 8.3 for KOOS Pain, 8.8 for KOOS Activities of Daily Living (ADL), 30.0 for KOOS Sports and Recreation, 18.8 for KOOS Quality of Life (QOL), 9.2 for IKDC, and 13.0 for Lysholm. The PASS values were 71.5 for KOOS Symptoms, 72.2 for KOOS Pain, 86.8 for KOOS ADL, 43.8 for KOOS Sports and Recreation, 50.0 for KOOS QOL, 62.1 for IKDC, and 70.0 for Lysholm. Patients with higher baseline scores were more likely to achieve PASS for the IKDC (odds ratio, 2.28; P = .03). Baseline score did not have an effect on the likelihood of achieving CID. Younger age was an independent predictor of achieving PASS and CID across all outcomes ( P < .05), but sex did not have such an effect. Conclusion: This study determined CID and PASS values for the KOOS, IKDC, and Lysholm scores among patients treated with knee cartilage restoration. Younger age was a positive prognostic variable, and higher baseline scores implied achieving PASS for the IKDC. The information in this study can be used in designing randomized controlled trials, counseling individual patients as to anticipated outcomes, and conducting responder analyses when evaluating new cartilage technology from a regulatory perspective.

show abstract

“…40 In a group of patients undergoing osteochondral grafts, the MCID for the IKDC was found to be 17 and higher pre-op Marx Activity Rating Scale score, lower pre-op SF-36 pain score, and history of less than one knee surgery was predictive of achieving this MCID. 41 In an effort to compare the IKDC and KOOS in patients with articular cartilage injury, Hambly and Griva surveyed 58 patients on the importance of each question in each PRO in relation to their symptoms and disabilities. 42 Each question was ranked by patients on a 6-point Likert scale ranging from "not experienced" to "experienced and extremely important."…”

Section: Knee-specific Patient-reported Outcomes Knee Injury and Ostementioning

confidence: 99%

Measuring Outcomes in Knee Articular Cartilage Pathology

Oak

Spindler

2020

J Knee Surg

View full text Add to dashboard Cite

Measuring outcomes following treatment of knee articular cartilage lesions is crucial to determine the natural history of disease and the efficacy of treatments. Outcome assessments for articular cartilage treatments can be clinical (based on failure, lack of healing, reoperation, need for arthroplasty), radiographic (X-ray, MRI), histologic, or patient reported and functional. The purpose of this review is to discuss the application and properties of patient-reported outcomes (PROs) with a focus on articular cartilage injuries and surgery in the knee. The most frequently used and validated PROs for knee articular cartilage studies include: the Knee injury and Osteoarthritis and Outcome Score, International Knee Documentation Committee Subjective Knee Form, and Lysholm score as knee-specific measures; the Marx Activity Rating Scale and Tegner Activity Scale as activity measures; and EQ-5D and SF-36/12 as generic quality-of-life measures. Incorporating these validated PROs in studies pertaining to knee articular cartilage lesions will allow researchers to fully capture clinically relevant outcomes that are most important to patients.

show abstract

Clinically Meaningful Improvement After Treatment of Cartilage Defects of the Knee With Osteochondral Grafts

Cited by 37 publications

References 50 publications

Defining the Minimal Clinically Important Difference and Patient Acceptable Symptom State for Microfracture of the Knee: A Psychometric Analysis at Short-term Follow-up

Defining the Minimal Clinically Important Difference and Patient Acceptable Symptom State for Microfracture of the Knee: A Psychometric Analysis at Short-term Follow-up

The Clinically Important Difference and Patient Acceptable Symptomatic State for Commonly Used Patient-Reported Outcomes After Knee Cartilage Repair

Measuring Outcomes in Knee Articular Cartilage Pathology

Contact Info

Product

Resources

About