The meniscal tear outcome (METRO) review: A systematic review summarising the clinical course and outcomes of patients with a meniscal tear

Clinically Meaningful Achievement in Outcomes After Subacromial Balloon Spacer Implantation: Letter to the Editor

“…However, we would contend this assumption is difficult to make, as it is unclear what trajectories are actually being compared in the context of the heterogeneous treatment groups created in their study. 1 Notably, they also caution that our results could be misleading by the way in which they were framed; however, in their study used for comparison, they report that they ''estimated data where numerical data was not available,'' inherently predisposing their calculated trajectories to potentially misleading results depending on how they chose to interpret it. Therefore, it is not appropriate to try to draw any conclusions between these populations based on the way in which they designed their study and treated data as they inherently influence health trajectory.…”

“…In supporting this concern, they cite their previous review, which demonstrated that patients experience improvement in several patient-reported outcome scores regardless of surgical treatment. 1 In this study, they categorized patients into 1 of 3 groups (repair, acromioplasty, or nonoperative), although when patients had other treatments in conjunction with the aforementioned interventions, such as the addition of an injection or other concomitant procedure, the authors also considered those patients to be part of the 3 primary groups. They note that the trajectory of improvement from studies included in our review was similar to those observed in their study, 1 which they then depicted graphically.…”

“…Where numerical data were not available, data were estimated from graphs as per previous methodology. 1,7 These data were transposed to our previous graph to show the pattern of change in the context of the data we extracted previously for 68 operative treatment arms.…”

“…1 In this study, they categorized patients into 1 of 3 groups (repair, acromioplasty, or nonoperative), although when patients had other treatments in conjunction with the aforementioned interventions, such as the addition of an injection or other concomitant procedure, the authors also considered those patients to be part of the 3 primary groups. They note that the trajectory of improvement from studies included in our review was similar to those observed in their study, 1 which they then depicted graphically. However, we would contend this assumption is difficult to make, as it is unclear what trajectories are actually being compared in the context of the heterogeneous treatment groups created in their study.…”

“…This is consistent with the fluctuating natural history of many musculoskeletal disorders. 1,2 Typically, people will seek treatment when their symptoms are more severe, meaning that whatever treatment they are given, over time they are likely to improve.…”