Research Pearls: The Significance of Statistics and Perils of Pooling. Part 1: Clinical Versus Statistical Significance

Harris, Joshua D.; Brand, Jefferson C.; Cote, Mark P.; Faucett, Scott C.; Dhawan, Aman

doi:10.1016/j.arthro.2017.01.053

Cited by 441 publications

(251 citation statements)

References 55 publications

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“…The time taken to return to this level varied between 5 and 12 months from the date of surgery; 93% of patients (n ¼ 65) improved their subjective IKDC score beyond the minimal clinically important difference value (16.7), and 97% (n ¼ 68) of patients have a final IKDC score superior to the patient acceptable symptom state value. 21 All patients improved their Lysholm score over the MDC value (8.9). The Tegner score was lower than the preoperative one without statistical significance, and 61 patients (87%) have a difference lower or equal to the Tegner minimum detectable change.…”

Section: Discussionmentioning

confidence: 81%

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Rosenstiel

Praz

Ouanezar

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose: To evaluate clinical outcomes in professional athletes after combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction at a minimum follow-up of 2 years. Methods: A retrospective analysis of prospectively collected data from the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group database was performed. All professional athletes who underwent primary combined ACL and ALL reconstruction between January 2011 and March 2016 were included. Patient assessment included physical examination, pre-and postoperative subjective and objective International Knee Documentation Committee (IKDC), Tegner activity scale, and Lysholm scores. Results: Seventy-two professional athletes underwent primary ACL and ALL reconstruction; 70 (97%) were available, with a mean follow-up of 3.9 years (range, 2-7). The preoperative side-to-side anteroposterior laxity difference was 7.1 AE 1.4 mm, and this decreased significantly after surgery to 0.4 AE 0.9 mm (P < .0001). Pivot-shift grade evolved from 16 grade I (22.8%) and 54 grade II or III (77.2%) preoperatively, to 66 absent pivot shift (94.3%) and 4 grade I (5.7; P < .001). By 1-year postoperatively, 60 athletes (85.7%) returned to professional sport, with a mean time interval of 7.9 months (range, 5-12). Preoperatively, the mean subjective IKDC was 56.1 AE 12.3, the Lysholm score was 48.4 AE 12.5, and the Tegner score was 9.3 AE 1. At final follow-up, the mean subjective IKDC was 90.5 AE 7.6 (P < .0001), the Lysholm score was 94.4 AE 7.5 (P < .0001), and the Tegner score was 8.8 AE 1.5 (P < .004). The objective IKDC evolved from 39 grade C (55.7%) and 31 grade D (44.3%) preoperatively to 65 grade A (92.9%) and 5 grade B (7.1%) (P < .0001). Eleven Patients (15,7%) underwent a subsequent ipsilateral reoperation including 4 (5.7%) revision ACL reconstructions. The risk of graft rupture was significantly higher in female patients (13.6% vs 2.1% in male patients; P ¼ .048). Conclusions: Combined ACL and ALL reconstruction is associated with excellent outcomes in professional athletes with respect to graft rupture rates, return to sport, knee stability, and reoperation rates after injury. Level of Evidence: Level IV, case series. See commentary on page 893 D espite a major focus on injury prevention, the rates of anterior cruciate ligament (ACL) rupture have remained relatively unchanged over the last 25 years. 1-3 ACL rupture continues to represent a devastating injury with potentially career-ending consequences for the professional athlete. Even for those

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Section: Discussionmentioning

confidence: 81%

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Rosenstiel

Praz

Ouanezar

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Despite the observation of statistically significant differences between pretreatment and posttreatments, a patient may or may not be capable of sensing those differences. 25 The smallest detectable change and minimal important change in KOOS activities of daily living were 15.7 and 18.4, respectively. In the current study, the difference in means between ACI and MF was 5.03 at 5-year follow-up.…”

Section: Discussionmentioning

confidence: 95%

Autologous Chondrocyte Implantation Versus Microfracture in the Knee: A Meta-analysis and Systematic Review

Gou

Tseng

Wang

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Mean Lysholm score improved significantly from 55.9 (standard deviation 11.4) to 91.2 (standard deviation 7.6) (power ¼ 1.00 and P < .001). Since the minimum detectable change of Lysholm score was 8.9, 16 all the 10 patients met minimum detectable change. There were no complications such as infections.…”

Section: Clinical Resultsmentioning

confidence: 98%

Benign Neglect of Anomalous Insertion of the Anterior Horn of the Medial Meniscus as an Incidental Finding During Knee Arthroscopy

Nagashima

Otani

Takeshima

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the clinical results following arthroscopic surgery in patients with anomaly of the anterior horn of the medial meniscus (AHMM) that was found unexpectedly during surgery and discuss whether resection is necessary in patients without anteromedial knee pain (AMKP). Methods: Between May 2014 and April 2017, a total of 387 knee arthroscopies in 379 patients were performed. Among these, 11 knees in 11 patients showed an anomalous insertion of the AHMM (incidence, 2.8%), and all 11 patients were included in this study. For these 11 patients, medical records including preoperative diagnosis, arthroscopic findings, and pre-and postoperative clinical evaluations were analyzed. Results: None of the patients complained of AMKP before arthroscopy. Two patients were diagnosed with lateral meniscus injury and the other 9 patients were diagnosed with medial meniscus injury. All anomalies of the AHMM were found incidentally during arthroscopic surgery. The anomaly formed a band-like structure arising from the anterior portion of the medial meniscus and was attached to the anterior aspect of the ACL and femoral intercondylar notch. All 11 patients underwent partial meniscectomy, but anomalies of the AHMM were not resected. One patient was excluded from clinical evaluation, as that patient required subsequent total knee arthroplasty due to osteoarthritis. For the other 10 patients, mean follow-up was 36.8 months (range, 26-61 months). Knee pain was relieved, and none developed postoperative AMKP. Mean Lysholm score improved significantly from 55.9 to 91.2 (P < .001). Conclusions: The incidence of the anomaly was 2.8% in our study. If the patient has no AMKP before arthroscopic surgery, anomaly of the AHMM is a silent lesion that does not warrant resection. Level of Evidence: Level IV, therapeutic case series

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Research Pearls: The Significance of Statistics and Perils of Pooling. Part 1: Clinical Versus Statistical Significance

Cited by 441 publications

References 55 publications

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Combined Anterior Cruciate and Anterolateral Ligament Reconstruction in the Professional Athlete: Clinical Outcomes From the Scientific Anterior Cruciate Ligament Network International Study Group in a Series of 70 Patients With a Minimum Follow-Up of 2 Years

Autologous Chondrocyte Implantation Versus Microfracture in the Knee: A Meta-analysis and Systematic Review

Benign Neglect of Anomalous Insertion of the Anterior Horn of the Medial Meniscus as an Incidental Finding During Knee Arthroscopy

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