Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Am J Sports Med. 2020 Mar;48(4):876-883. doi: 10.1177/0363546520903279. Epub 2020 Feb 14.
Several studies have investigated failure rates and magnitude of improvement in patient-reported outcome measures after microfracture surgery for focal chondral defects of the knee; however; what constitutes clinically significant improvement in this patient population is poorly understood.
To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for microfracture surgery including the time-dependent nature of these thresholds and (2) identify predictors of achieving the MCID and PASS in patients specifically undergoing microfracture of the knee.
Case series; Level of evidence, 4.
A secure institutional cartilage preservation repository was queried for all patients who underwent microfracture between 2004 and 2017. The distribution method was used to calculate MCID thresholds for the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS), whereas an anchor-based method was used for the PASS. Multivariate logistic regressions were constructed to determine predictors of achieving the MCID and PASS.
A total of 206 patients with a mean ± SD age of 33.7 ± 13.2 years and body mass index of 26.9 ± 5.3 kg/m were included. All thresholds for the MCID and PASS increased over time except for the MCID thresholds for the KOOS Sports and Symptoms subscales. The proportion of patients who achieved the MCID (6 months, 78.4%; 12 months, 83.9%; 24 months, 88.6%) and PASS (6 months, 67.7%; 12 months, 79.2%; 24 months, 76.1%) generally increased over time. Older age and larger lesion size were negative independent predictors of MCID achievement. Older age was also a negative predictor of the PASS, whereas male sex and higher preoperative KOOS Symptoms and Pain scores were positive independent predictors of the PASS.
The MCID and PASS thresholds for the IKDC and KOOS in patients undergoing microfracture of the knee are dynamic, with an increasing number of patients achieving the MCID over time. The percentage achieving the PASS increased between 6 and 12 months and then declined slightly at 24 months. Independent predictors of achieving the MCID were lesion size and age at surgery, whereas predictors of achieving the PASS included lesion size, male sex, and greater preoperative KOOS Symptoms and Pain scores.
多项研究已经调查了膝关节微骨折手术治疗局灶性软骨缺损后患者报告的结局测量指标的失败率和改善程度；然而，对于该患者人群，什么是临床上显著的改善仍知之甚少。
（1）确定微骨折手术的最小临床重要差异（MCID）和可接受的患者症状状态（PASS）阈值，包括这些阈值的时间依赖性，以及（2）确定在特定接受膝关节微骨折的患者中达到 MCID 和 PASS 的预测因素。
病例系列；证据水平，4 级。
通过安全的机构软骨保存库，对 2004 年至 2017 年间接受微骨折手术的所有患者进行了查询。使用分布法计算国际膝关节文献委员会（IKDC）评分和膝关节损伤和骨关节炎结果评分（KOOS）的 MCID 阈值，而 PASS 则使用锚定法。构建多变量逻辑回归模型，以确定达到 MCID 和 PASS 的预测因素。
共纳入 206 例患者，平均年龄±标准差为 33.7±13.2 岁，体重指数为 26.9±5.3kg/m。除 KOOS 运动和症状子量表的 MCID 阈值外，所有 MCID 和 PASS 的阈值均随时间增加。达到 MCID（6 个月时为 78.4%；12 个月时为 83.9%；24 个月时为 88.6%）和 PASS（6 个月时为 67.7%；12 个月时为 79.2%；24 个月时为 76.1%）的患者比例总体随时间增加。年龄较大和病变较大是达到 MCID 的负独立预测因素。年龄较大也是 PASS 的负预测因素，而男性和较高的术前 KOOS 症状和疼痛评分是 PASS 的正独立预测因素。
膝关节微骨折患者的 IKDC 和 KOOS 的 MCID 和 PASS 阈值是动态的，随着时间的推移，越来越多的患者达到 MCID。达到 PASS 的百分比在 6 至 12 个月之间增加，然后在 24 个月时略有下降。达到 MCID 的独立预测因素是病变大小和手术时的年龄，而达到 PASS 的预测因素包括病变大小、性别和较高的术前 KOOS 症状和疼痛评分。
