Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation

Abstract

Background:Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery.Purpose:To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS.Results:A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A ), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL).Conclusion:This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers’ compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.

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

“…Recently, Liu et al determined the minimal clinically important difference (MCID) and patient acceptable symptom states (PASS) for MAT [ 11 ]. We did not establish PASS or MCID in our population, but positive answers to the questions about patients’ opinion regarding MAT ranged from 71 to 93%, with 91% in particular regarding patients satisfaction after MAT.…”

“…We did not establish PASS or MCID in our population, but positive answers to the questions about patients’ opinion regarding MAT ranged from 71 to 93%, with 91% in particular regarding patients satisfaction after MAT. We are aware that PASS thresholds can be patient population specific [ 11 ] and can alter in follow-up time [ 9 , 10 ]. Nevertheless, compared to baseline level, all KOOS scores were above both the MCID and the PASS as given by Lui et al [ 11 ] at any follow-up moment in our population.…”

“…We are aware that PASS thresholds can be patient population specific [ 11 ] and can alter in follow-up time [ 9 , 10 ]. Nevertheless, compared to baseline level, all KOOS scores were above both the MCID and the PASS as given by Lui et al [ 11 ] at any follow-up moment in our population. This confirms the patient-reported success of MAT in our cohort.…”

“…As second aim, overall meniscal allograft survival at long-term follow-up was evaluated. Recently, minimal clinically important difference (MCID) and patient acceptable symptom states (PASS) for MAT were determined [ 11 ]; however, patients’ expectations and satisfaction about this procedure are still unknown and should potentially be considered as significant entities in the overall result of MAT. Thus, as our third aim, patient’s expectations and satisfaction about MAT were evaluated.…”

Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study

“…The number of patients achieving the Patient Acceptable Symptom State (PASS) for Lysholm and KOOS subscales was calculated. 16 Moreover, a 0- to 100-point scale for overall knee function and for global satisfaction was administered. Patients were asked whether they would repeat the procedure if needed.…”