Factors Associated With Clinically Significant Patient-Reported Outcomes After Primary Arthroscopic Partial Meniscectomy

Gowd, Anirudh K.; Lalehzarian, Simon P.; Liu, Joseph N.; Agarwalla, Avinesh; Christian, David R.; Forsythe, Brian; Cole, Brian J.; Verma, Nikhil N.

doi:10.1016/j.arthro.2018.12.014

Cited by 58 publications

(51 citation statements)

References 53 publications

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“…The MCID, SCB and PASS values used in this analysis were derived from previously published research using the same institutional group. 13 These values were derived using both anchor-based and distribution-based approaches relying on a Global Assessment Scale as e724 previously described in the literature. [28][29][30] Distributionbased MCID values were used for time-dependent analysis, given that area-under-curve values for anchor-based MCID calculations were all < 70%.…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30] Distributionbased MCID values were used for time-dependent analysis, given that area-under-curve values for anchor-based MCID calculations were all < 70%. 13 Anchor-based values were used for SCB and PASS, given that area-under-curve values were all > 70% for SCB and > 85% for PASS. 13 Linear regression was used to examine the relationship between time and PROM scores at preoperative, 6-month, 12-month and 24-month timepoints.…”

Section: Discussionmentioning

confidence: 99%

“…Younger age, 9 minimal arthritis 10 and simple tear types 11,12 are a few predictors of favorable outcomes by this measure. 13 .…”

mentioning

confidence: 99%

“…21 Although these threshold scores have been established for APM. 13 there is little research regarding the time at which they are achieved. 22,23 Defining the time-to-achievement relationship in APM is particularly relevant in the context of pay-for-performance models being increasingly adopted in the current American health care landscape.…”

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confidence: 99%

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Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

Beletsky

Gowd

Liu

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Younger age, 9 minimal arthritis 10 and simple tear types 11,12 are a few predictors of favorable outcomes by this measure. 13 .…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

Beletsky

Gowd

Liu

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

Self Cite

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show abstract

“…See related article on page 241 P atient-centered metrics have become increasingly studieddand for good reason. [1][2][3][4][5][6][7] When well executed, these studies translate raw clinical outcome scores into nicely packaged, easy-to-interpret metrics that indicate just how much a patient has improved. The article "How Should We Define Clinically Significant Improvement on Patient-Reported Outcomes Measurement Information System for Patients Undergoing Knee Meniscal Surgery?"…”

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confidence: 99%

Editorial Commentary: Defining Improvement After Arthroscopic Meniscal Surgery—How Much of a Difference Does a Difference Make?

Cote¹

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patient-centered metrics including the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state have been proposed to determine the clinical significance of patient-reported outcome scores. These values allow clinically meaningfully interpretation of changes in scores such that the degree of improvement (minimal clinically important difference and substantial clinical benefit) and satisfaction (patient acceptable symptom state) can be determined. When derived in the same study, these values allow analyses to be approached from the perspective of which patients are likely to respond to treatment and what level of improvement and satisfaction they might attain. Although limited to the sample from which they are derived, these metrics go beyond a mean value of an outcome score to provide a patient-centered perspective that informs the clinical significance of patient-reported outcome scores.

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Preoperative subjective assessment of disease‐specific quality of life significantly influenced the likelihood of achieving the minimal clinically important difference after surgical stabilization for recurrent lateral patellar instability

Dan Milinkovic,

Schmidt,

Fluegel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo evaluate which factors exert a predictive value for not reaching the minimal clinically important difference (MCID) in patients who underwent a tailored operative treatment for recurrent lateral patellar dislocation (RLPD).MethodsA total of 237 patients (male/female 71/166; 22.4 ± 6.8 years) were included. The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and subjective rating of knee function and pain (numeric analogue scale [NAS]; 0–10) were used to evaluate patients' outcomes from pre‐ to postoperatively. Gender, age at the time of surgery, body mass index (BMI), nicotine abuse, psychiatric diseases, cartilage status and pathoanatomic risk factors were evaluated as potential predictors for achieving the MCID using univariate logistic regression analysis.ResultsThe MCID for the BPII 2.0 was calculated at 9.5 points. Although the BPII 2.0 and NAS for knee function and pain improved significantly in the total cohort from pre‐ to postoperatively (all p < 0.001), 29 patients did not reach the MCID at the final follow‐up. The analysis yielded that only the preoperative NAS for function and BPII 2.0 score values were significant predictors for reaching the MCID postoperatively. The optimal threshold was calculated at 7 (NAS function) and 65.2 points (BPII 2.0). Age at the time of surgery should be considered for patients with a preoperative BPII 2.0 score >62.5.ConclusionThe probability of reaching BPII 2.0 MCID postoperatively depends only on the preoperative BPII 2.0 value and subjective rating of knee function, as well as age at the time of surgery for patients undergoing surgical treatment of RLPD. Here, presented results can assist clinicians in advising and presenting patients with potential outcomes following treatment for this often complex and multifactorial pathology.Level of EvidenceLevel III.

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Factors Associated With Clinically Significant Patient-Reported Outcomes After Primary Arthroscopic Partial Meniscectomy

Cited by 58 publications

References 53 publications

Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

Editorial Commentary: Defining Improvement After Arthroscopic Meniscal Surgery—How Much of a Difference Does a Difference Make?

Preoperative subjective assessment of disease‐specific quality of life significantly influenced the likelihood of achieving the minimal clinically important difference after surgical stabilization for recurrent lateral patellar instability

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