Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Department of Orthopaedics, Lillebaelt Hospital, Kolding, Denmark.
Br J Sports Med. 2017 Mar;51(6):525-530. doi: 10.1136/bjsports-2016-096456. Epub 2016 Sep 16.
The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery.
This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies.
Regression models only explained a small proportion of the variability in self-reported pain and function (adjusted R=0.10-0.12) and this association was mainly driven by age, gender and body mass index.
Specific meniscal pathology and other structural joint pathologies found at meniscal surgery were not associated with preoperative self-reported pain and function in patients with meniscal tears questioning inferences made about a direct relationship between these. Our findings question the role of arthroscopic surgery to address structural pathology as a means to improve patient-reported outcomes in patients having surgery for a meniscal tear.
半月板撕裂与其他关节病变与患者报告的症状之间的关系尚不清楚。我们研究了在接受关节镜半月板手术的患者中，手术中确定的结构性膝关节病变与术前膝关节疼痛和功能之间的关系。
本研究纳入了来自丹麦南部膝关节镜队列研究（Knee Arthroscopy Cohort Southern Denmark，KACS）的 443 名患者，这是一项前瞻性队列研究，纳入了 2013 年 2 月 1 日至 2014 年 1 月 31 日期间在 4 家医院接受关节镜半月板手术的 18 岁及以上患者。在手术前，通过在线问卷获得了患者报告的结果，包括膝关节损伤和骨关节炎结果评分（Knee Injury and Osteoarthritis Outcome Score，KOOS）。膝关节病变由手术医生使用改良的国际膝关节镜协会、膝关节外科和矫形运动医学协会（International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine，ISAKOS）半月板撕裂问卷进行评估，并辅以从手术报告中提取的信息。在对候选变量进行假设驱动的预选择后，采用向后消除回归法研究了患者报告的结果与结构性膝关节病变之间的关系。
回归模型仅能解释自我报告的疼痛和功能的一小部分变化（调整后的 R=0.10-0.12），这种关联主要受年龄、性别和体重指数的影响。
在半月板撕裂患者中，半月板手术中发现的特定半月板病变和其他结构性关节病变与术前自我报告的疼痛和功能无关，这对这些病变之间存在直接关系的推断提出了质疑。我们的研究结果对关节镜手术解决结构性病变以改善因半月板撕裂而接受手术的患者报告的结果的作用提出了质疑。
