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Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation.
Orthop J Sports Med 2019; 7(1):2325967118818462OJ

Abstract

Background

Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery.

Purpose

To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values.

Study Design

Cohort study (diagnosis); Level of evidence, 2.

Methods

A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS.

Results

A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL).

Conclusion

This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers' compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.

Authors+Show Affiliations

Department of Orthopaedics, Loma Linda University, Loma Linda, California, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30643837

Citation

Liu, Joseph N., et al. "Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation." Orthopaedic Journal of Sports Medicine, vol. 7, no. 1, 2019, p. 2325967118818462.
Liu JN, Gowd AK, Redondo ML, et al. Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthop J Sports Med. 2019;7(1):2325967118818462.
Liu, J. N., Gowd, A. K., Redondo, M. L., Christian, D. R., Cabarcas, B. C., Yanke, A. B., & Cole, B. J. (2019). Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthopaedic Journal of Sports Medicine, 7(1), p. 2325967118818462. doi:10.1177/2325967118818462.
Liu JN, et al. Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. Orthop J Sports Med. 2019;7(1):2325967118818462. PubMed PMID: 30643837.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation. AU - Liu,Joseph N, AU - Gowd,Anirudh K, AU - Redondo,Michael L, AU - Christian,David R, AU - Cabarcas,Brandon C, AU - Yanke,Adam B, AU - Cole,Brian J, Y1 - 2019/01/04/ PY - 2019/1/16/entrez PY - 2019/1/16/pubmed PY - 2019/1/16/medline KW - clinical outcomes KW - meniscal allograft transplant KW - minimal clinically important difference KW - patient acceptable symptomatic state SP - 2325967118818462 EP - 2325967118818462 JF - Orthopaedic journal of sports medicine JO - Orthop J Sports Med VL - 7 IS - 1 N2 - Background: Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery. Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS. Results: A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m2. The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL). Conclusion: This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers' compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT. SN - 2325-9671 UR - https://www.unboundmedicine.com/medline/citation/30643837/Establishing_Clinically_Significant_Outcomes_After_Meniscal_Allograft_Transplantation_ L2 - http://journals.sagepub.com/doi/full/10.1177/2325967118818462?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -