Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study

Abstract

Objectives To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. Design Comparative prospective cohort study. Setting Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015. Participants Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). Interventions Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires. Main outcome measures Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index. Results 397 eligible adults (42% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4 scores than those with traumatic tears (adjusted between-group difference −5.1 (95% confidence interval −8.9 to −1.3); P=0.008). In the analysis including KOOS4 score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful. Conclusions These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears. Trial registration ClinicalTrials.gov identifier NCT01871272.

Diagnostic Validity of Combining History Elements and Physical Examination Tests for Traumatic and Degenerative Symptomatic Meniscal Tears

“…More than 60% of all SMT cases in our cohort reported having no mechanical symptoms as reported on individual questions from the KOOS questionnaire. This result is comparable with other cohorts with meniscal tears [3,5,21,22,51]. Also, mechanical symptoms, when present, do not arise exclusively from meniscal tears and may be positive in other disorders such as ACL tear or osteoarthritis [3,6].…”

Can we predict the clinical outcome of arthroscopic partial meniscectomy? A systematic review

“…The findings of Salata et al  are in concordance with Englund et al 56 who found that degenerative meniscal tears result in worse clinical and radiological outcome after 16 years in 155 patients undergoing APM. By contrast, a recently published and methodologically robust study of Thorlund et al 57 reported no clinically relevant difference in patient-reported knee function and satisfaction between degenerative and traumatic meniscal tears after 12 months. This is in line with the results of the current systematic review, in which no difference in patient-reported clinical outcome between non-traumatic and traumatic tears was found as well.…”

Risk factors, diagnosis and non-surgical treatment for meniscal tears: evidence and recommendations: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF)

“…Different approaches to classify meniscal tears as traumatic or degenerative can be found in the literature. Some are based on symptom onset alone,69 whereas others use a combination of age and symptom onset70 as osteoarthritic changes and meniscal degeneration are linked to older age. Clearly, a ‘gray zone’ exists where it can be difficult to discern.…”