Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions

Graaf, Victor A. van de; Bloembergen, Coen H; Willigenburg, Nienke W.; Noorduyn, Julia C A; Saris, Daniël B.F.; Harris, Ian; Poolman, Rudolf W.

doi:10.1136/bjsports-2019-100567

Cited by 30 publications

(27 citation statements)

References 35 publications

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“…Orthopedic surgeons received baseline characteristics of the patient including demographic information about employment, age and BMI, PROMs on pain, knee function and mechanical dysfunction, and MRI results on tear type and location, and radiograph information on level of knee osteoarthritis. Similar to the results of this study, they found that orthopedic surgeons were also unable to accurately predict which patient would benefit from physical therapy based on the baseline characteristics [20]. Positive beta is indicative that a higher score results in a higher probability of undergoing a meniscal surgery; a negative coefficient indicates that this risk increased with lower score.…”

Section: Discussionsupporting

confidence: 75%

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

Noorduyn

Teuwen

Graaf

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those patients with a degenerative meniscal tear who will undergo surgery following physical therapy. Methods The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45–70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients’ baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of p < 0.157. For both models the performance was assessed and corrected for the models’ optimism through an internal validation using bootstrapping technique with 500 repetitions. Results At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy. Conclusion Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models. Level of evidence III.

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Section: Discussionsupporting

confidence: 75%

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

Noorduyn

Teuwen

Graaf

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Identifying patients with degenerative meniscal tears who have poor prognosis remains an unsolved puzzle, and research focusing on finding variables that influence treatment outcome is needed. 38 Our data provide evidence of specific prognostic factors for function in sport and recreational activities.…”

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confidence: 64%

On a Trajectory for Success—9 in Every 10 People With a Degenerative Meniscus Tear Have Improved Knee Function Within 2 Years After Treatment: A Secondary Exploratory Analysis of a Randomized Controlled Trial

Berg¹,

Roos²,

Kise³

et al. 2021

Journal of Orthopaedic & Sports Physical Therapy

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The prevalence of degenerative meniscal tears ranges from 19% to 56%. 10 Patients with symptomatic degenerative meniscal tears presenting to clinical practice often report knee pain and functional limitations of moderate to extreme severity. 35,36 In cohort studies, poorer functional performance, lower activity level, larger meniscus excision, meniscal extrusion, and radiographic knee osteoarthritis are prognostic factors for worse outcomes. 9,19,21 These data suggest that there are subgroups of individuals with poor outcomes.U OBJECTIVE: To identify trajectories of patient-reported knee function over 5 years in patients with degenerative meniscal tears, and to explore whether baseline characteristics were associated with trajectories of sport and recreational function.U DESIGN: Prospective cohort study.U METHODS: We conducted a secondary exploratory analysis of the Odense-Oslo Meniscectomy Versus Exercise randomized controlled trial. Patient-reported knee function was assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 3 months, 1 year, 2 years, and 5 years. We used group-based trajectory modeling to identify subgroups of patients who followed distinctive patterns of change. Multinomial logistic regression was used to examine the associations of patient demographics, knee function, and disease-related factors with KOOS sport and recreational function subscale trajectories.U RESULTS: The analysis of data from a sample of 140 participants identified 3 trajectories for all KOOS subscales: (1) low, minimal improvement (10%-12% of the participants), (2) moderate, gradual improvement (20%-36%), and (3) high, early improvement (53%-70%). Baseline prognostic factors for deteriorating function in sport and recreational activities were higher body mass index, poorer mental health, greater knee pain, lower perceived knee function, poorer quadriceps and hamstrings muscle strength, poorer functional performance, more meniscal extrusion, and radiographic signs of knee osteoarthritis.U CONCLUSION: We found 3 distinct trajectories of patient-reported knee function over 5 years: (1) low, minimal improvement, (2) moderate, gradual improvement, and (3) high, early improvement. Nine in every 10 participants improved at least gradually over 2 years after diagnosis of a degenerative meniscal tear.

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“…However, this is comparable with other studies that have had similar outcomes (11% to 17% response rate) when surveying orthopaedic surgeons. 10 , 31 This low response rate creates a risk of selection bias. In the first survey, 53% of respondents routinely repaired the PQ muscle, while in the second this was reduced to 43%.…”

Section: Discussionmentioning

confidence: 99%

Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons?

et al. 2020

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Aims The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities. Methods Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year. Results Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, six of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle. Conclusion The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference. Cite this article: Bone Joint Open 2020;1-9:549–555.

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Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions

Cited by 30 publications

References 35 publications

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

On a Trajectory for Success—9 in Every 10 People With a Degenerative Meniscus Tear Have Improved Knee Function Within 2 Years After Treatment: A Secondary Exploratory Analysis of a Randomized Controlled Trial

Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons?

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