Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Midwest Orthopaedics at Rush, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
J Arthroplasty. 2023 Dec;38(12):2580-2586. doi: 10.1016/j.arth.2023.05.084. Epub 2023 Jun 5.
The purposes of the study were to define the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after patello-femoral inlay arthroplasty (PFA) and to identify factors predictive for the achievement of clinically important outcomes (CIOs).
A total of 99 patients who underwent PFA between 2009 and 2019 and had a minimum of 2-year postoperative follow-up were enrolled in this retrospective monocentric study. Included patients had a mean age of 44 years (range, 21 to 79). The MCID and PASS were calculated using an anchor-based approach for the visual analog scale (VAS) pain, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Lysholm patient-reported outcome measures. Factors associated with CIO achievement were determined using multivariable logistic regression analyses.
The established MCID thresholds for clinical improvement were -2.46 for the VAS pain score, -8.5 for the WOMAC score, and + 25.4 for the Lysholm score. Postoperative scores corresponding to the PASS were <2.55 for the VAS pain score, <14.6 for the WOMAC score, and >52.5 points for the Lysholm score. Preoperative patellar instability and concomitant medial patello-femoral ligament reconstruction were independent positive predictors of reaching both MCID and PASS. Additionally, inferior baseline scores and age were predictive of achieving MCID, whereas superior baseline scores and body mass index were predictive of achieving PASS.
This study determined the thresholds of MCID and PASS for the VAS pain, WOMAC, and Lysholm scores following PFA implantation at 2-year follow-up. The study demonstrated a predictive role of patient age, body mass index, preoperative patient-reported outcome measure scores, preoperative patellar instability, and concomitant medial patello-femoral ligament reconstruction in the achievement of CIOs.
Prognostic Level IV.
本研究旨在定义髌股关节镶嵌式假体置换术（PFA）后最小临床重要差异（MCID）和患者可接受的症状状态（PASS），并确定预测达到临床重要结局（CIOs）的因素。
本回顾性单中心研究纳入了 2009 年至 2019 年间接受 PFA 治疗且术后至少随访 2 年的 99 例患者。纳入患者的平均年龄为 44 岁（范围 21-79 岁）。采用基于锚定的视觉模拟量表（VAS）疼痛、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）和 Lysholm 患者报告结局测量的方法来计算 MCID 和 PASS。使用多变量逻辑回归分析确定与 CIO 实现相关的因素。
确立的临床改善 MCID 阈值为 VAS 疼痛评分-2.46、WOMAC 评分-8.5 和 Lysholm 评分+25.4。与 PASS 相对应的术后评分 VAS 疼痛评分<2.55、WOMAC 评分<14.6 和 Lysholm 评分>52.5。术前髌骨不稳定和内侧髌股韧带重建是达到 MCID 和 PASS 的独立正预测因素。此外，基线较差的评分和年龄是达到 MCID 的预测因素，而基线较好的评分和体重指数是达到 PASS 的预测因素。
本研究确定了 PFA 植入术后 2 年时 VAS 疼痛、WOMAC 和 Lysholm 评分的 MCID 和 PASS 阈值。研究表明，患者年龄、体重指数、术前患者报告结局测量评分、术前髌骨不稳定和内侧髌股韧带重建在达到 CIOs 方面具有预测作用。
预后 IV 级。
