Warner Tyler, Lowenstein Natalie, Mazzocca Jillian, Collins Jamie, Matzkin Elizabeth
Harvard Medical School, Boston, Massachusetts, U.S.A.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Mar 19;6(3):100926. doi: 10.1016/j.asmr.2024.100926. eCollection 2024 Jun.
To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear.
This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB).
Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up.
At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients.
Level IV, therapeutic case series.
评估术前膝关节X线片为凯尔格伦-劳伦斯（KL）3级且有症状性半月板撕裂的患者在关节镜下半月板部分切除术（APM）后的患者报告结局指标（PROMs）。
这是一项回顾性研究设计，使用来自单一机构的前瞻性收集数据。如果患者术前膝关节X线片显示KL 3级骨关节炎，并且在APM前完成了至少6周的非手术治疗试验，则纳入研究。如果患者患有炎症性关节炎、术前和/或术后1年随访数据不完整、重复膝关节镜检查以及伴有韧带损伤，则排除在外。统计分析使用术前和术后2年内的PROMs，通过具有先前确定阈值的量表来评估改善情况，包括最小临床重要差异（MCID）和实质性临床获益（SCB）。
82例患者符合纳入标准（49例女性[60%]，平均[标准差]年龄53.1[9.3]岁）。在1年随访时，大多数患者达到了MCID：膝关节损伤和骨关节炎结局评分（KOOS）疼痛亚量表中为73%，KOOS症状亚量表中为66%，KOOS日常生活活动（ADL）亚量表中为78%。在2年随访时，这些改善情况相似：各亚量表分别为75%、72%和79%。术后1年也显示出SCB，KOOS疼痛、症状和ADL亚量表中分别有56%、73%和71%的患者达到SCB。这些结果在2年随访时基本持续存在。疼痛的视觉模拟量表评分在术后1年和2年时也有所改善，平均较基线分别提高2.80分和2.87分。马克思活动评分从基线到1年和2年随访时平均下降。
至少在1年随访时，大多数KL 3级且有半月板撕裂的患者在KOOS疼痛、KOOS症状和KOOS ADL方面达到了MCID和SCB，表明这些患者的结局有有意义的改善。
IV级，治疗性病例系列。
