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

Abstract

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.

What Is the Clinical Benefit of Common Orthopaedic Procedures as Assessed by the PROMIS Versus Other Validated Outcomes Tools?

“…This is particularly true for procedures with longer recovery periods, such as TKA and PLF. However, we believe our results retain validity as prior outcomes research demonstrates a plateau in improvement for these procedures 6 months after surgery [2, 5, 13, 27, 28, 36]. Additionally, between 25% and 35% of patients did not have both pre- and postoperative scores, which introduces transfer bias.…”

Clinical outcomes one year after a digital musculoskeletal (MSK) program: an observational, longitudinal study with nonparticipant comparison group

“…Next, we calculated the change from baseline to follow-up. A person achieved MCID in functional improvement if they showed at least: 30% improvement on the RMDQ-11 [20,21]; or 8 point improvement on the KOOS-PS [22][23][24]; or 9.3 point improvement on the HOOS-PS [25,26]; or 13 point improvement on the SPADI [27][28][29]; or 12 point improvement on the sf-NPAD [30,31]; or no limitations at follow-up.…”

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“…These results are important as the use of a previously reported SCB values as a surrogate for identifying patients who have experienced substantial benefit has become more prevalent in shoulder arthroplasty research, 2 , 5 , 7 , 16 and the orthopedic literature in general. 1 , 3 , 6 , 11 While this well-intended approach allows the results to be viewed from the perspective of clinical significance, it is reliant upon the stability of the SCB as it relates to the outcome measure and patient population of interest. If the SCB being utilized is considerably different than the true SCB of the patient group under study, the interpretation of these results could be misleading.…”