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Wild-goose chase, no predictable patient subgroups who benefit from meniscal surgery : patient-reported outcomes of 641 patients 1 year after surgery

Pihl, Kenneth; Ensor, Joie; Peat, George; Englund, Martin LU ; Lohmander, Stefan LU ; Jørgensen, Uffe; Nissen, Nis; Fristed, Jakob Vium and Thorlund, Jonas Bloch (2019) In British journal of sports medicine
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.

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author
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Contribution to journal
publication status
epub
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in
British journal of sports medicine
publisher
BMJ Publishing Group
external identifiers
  • scopus:85067104443
ISSN
1473-0480
DOI
10.1136/bjsports-2018-100321
language
English
LU publication?
yes
id
2717c572-750c-405b-a753-dea71a354ce9
date added to LUP
2019-06-20 11:21:31
date last changed
2019-07-16 04:12:03
@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},
  month        = {06},
  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},
  year         = {2019},
}