Wild-goose chase, no predictable patient subgroups who benefit from meniscal surgery : patient-reported outcomes of 641 patients 1 year after surgery
(2020) In British journal of sports medicine 54(1). p.13-22- Abstract
BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM.
OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups.
METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The... (More)
BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM.
OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups.
METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS4) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS4 change score constitutes improvement. Prognostic performance was assessed using R2 statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples.
RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS4. The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R2=0.162, optimism adjusted R2=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772).
CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery.
TRIAL REGISTRATION NUMBER: NCT01871272.
(Less)
- author
- Pihl, Kenneth ; Ensor, Joie ; Peat, George ; Englund, Martin LU ; Lohmander, Stefan LU ; Jørgensen, Uffe ; Nissen, Nis ; Fristed, Jakob Vium and Thorlund, Jonas Bloch
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- in
- British journal of sports medicine
- volume
- 54
- issue
- 1
- pages
- 13 - 22
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85067104443
- pmid:31186258
- ISSN
- 1473-0480
- DOI
- 10.1136/bjsports-2018-100321
- language
- English
- LU publication?
- yes
- additional info
- © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
- id
- 2717c572-750c-405b-a753-dea71a354ce9
- date added to LUP
- 2019-06-20 11:21:31
- date last changed
- 2024-08-20 21:37:31
@article{2717c572-750c-405b-a753-dea71a354ce9, abstract = {{<p>BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM.</p><p>OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups.</p><p>METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS4) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS4 change score constitutes improvement. Prognostic performance was assessed using R2 statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples.</p><p>RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS4. The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R2=0.162, optimism adjusted R2=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772).</p><p>CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery.</p><p>TRIAL REGISTRATION NUMBER: NCT01871272.</p>}}, author = {{Pihl, Kenneth and Ensor, Joie and Peat, George and Englund, Martin and Lohmander, Stefan and Jørgensen, Uffe and Nissen, Nis and Fristed, Jakob Vium and Thorlund, Jonas Bloch}}, issn = {{1473-0480}}, language = {{eng}}, number = {{1}}, pages = {{13--22}}, publisher = {{BMJ Publishing Group}}, series = {{British journal of sports medicine}}, title = {{Wild-goose chase, no predictable patient subgroups who benefit from meniscal surgery : patient-reported outcomes of 641 patients 1 year after surgery}}, url = {{http://dx.doi.org/10.1136/bjsports-2018-100321}}, doi = {{10.1136/bjsports-2018-100321}}, volume = {{54}}, year = {{2020}}, }