Predictors of short-term recovery differ from those of long-term outcome after arthroscopic partial meniscectomy

Impact of Obesity, Smoking, and Age on 30-Day Postoperative Outcomes of Patients Undergoing Arthroscopic Meniscus Surgery

BACKGROUND

The purpose of this study was to evaluate the impact that obesity, smoking, and older age have on 30-day postoperative complications, reoperations, and readmissions of patients undergoing arthroscopic meniscectomy or meniscus repair.

MATERIALS AND METHODS

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was queried to identify meniscus surgeries and operative outcomes between 2008 and 2016. Controlled regression analysis was then performed to evaluate for an association between obesity, age, and smoking and these outcomes.

RESULTS

While obesity showed no influence on adverse postoperative complications or reoperations, class I obesity was associated with a lower rate of readmission. Older age, smoking, and comorbidity burden were significant predictors of postoperative complications, reoperations, and/or readmissions. Age 80 years or older was particularly predictive of 30-day complications (odds ratio, 3.5; P<.001) and readmissions (odds ratio, 2.5; P=.004).

CONCLUSION

Obesity is not a major risk factor for complications when undergoing meniscus surgery, while age older than 70 years predicts negative short-term postoperative outcomes. [Orthopedics. 20XX;4X(X):XXX-XXX.].

Unraveling sex-specific risks of knee osteoarthritis before menopause: Do sex differences start early in life?

OBJECTIVE

Sufficient evidence within the past two decades have shown that osteoarthritis (OA) has a sex-specific component. However, efforts to reveal the biological causes of this disparity have emerged more gradually. In this narrative review, we discuss anatomical differences within the knee, incidence of injuries in youth sports, and metabolic factors that present early in life (childhood and early adulthood) that can contribute to a higher risk of OA in females.

DESIGN

We compiled clinical data from multiple tissues within the knee joint-since OA is a whole joint disorder-aiming to reveal relevant factors behind the sex differences from different perspectives.

RESULTS

The data gathered in this review indicate that sex differences in articular cartilage, meniscus, and anterior cruciate ligament are detected as early as childhood and are not only explained by sex hormones. Aiming to unveil the biological causes of the uneven sex-specific risks for knee OA, we review the current knowledge of sex differences mostly in young, but also including old populations, from the perspective of (i) human anatomy in both healthy and pathological conditions, (ii) physical activity and response to injury, and (iii) metabolic signatures.

CONCLUSIONS

We propose that to close the gap in health disparities, and specifically regarding OA, we should address sex-specific anatomic, biologic, and metabolic factors at early stages in life, as a way to prevent the higher severity and incidence of OA in women later in life.

Predictive Factors Influencing the Return to Sports Following Arthroscopic Knee Meniscectomy in Sports Persons: A Prospective Cohort Study

Meniscus tears are among the common knee injuries in sports, with arthroscopic meniscectomy being one of the most commonly performed orthopedic procedures. Return to sports of the same level following arthroscopic meniscectomy is an important aspect for athletes. Numerous factors may influence the time required for athletes to resume sports activities after meniscectomy. This prospective cohort study aimed to investigate the timeframe for returning to sports in athletes who underwent arthroscopic meniscectomy and to identify predictive factors that influence this return. Ninety sports persons who had undergone arthroscopic meniscectomy were included in this study. The patients were analyzed for their time to return to sports and nine proposed predictive factors that may influence their return to sports. Out of the 90 participants, 75 were able to return to their previous activity level, while the remaining 15 were unable to do so. Among the nine pre-defined factors studied, age older than 25 years (p < 0.0001), participation in non-contact sports (p < 0.0001), and engagement in recreational activities (p < 0.0001) were found to be statistically significant. In conclusion, this study reveals that with the increase in age, time to return to sports following arthroscopic meniscectomy increases. Additionally, athletes involved in non-contact sports and those having recreational sports activity levels experience greater delays in their return to sports as compared to athletes involved in combat and contact sports and athletes having elite and competitive sports levels, respectively.

Effects of proprioceptive training in the recovery of patients submitted to meniscus surgery: systematic review and meta-analysis

OBJECTIVE

To evaluate the effects of proprioceptive training on rehabilitation of knee after arthroscopic partial meniscectomy (APM).

DESIGN

PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, Technology Periodical Database, WanFang Data and China Biology Medicine were searched until December 2021 for randomised controlled trials.

PARTICIPANTS

Patients who have undergone APM for meniscus injury caused by traumatic tear.

RESULTS

A total of 9 studies with 453 patients were included in this study for meta-analysis, and 2/9 with high quality, 6/9 with moderate quality. Based on very low quality evidence, the pooled effect showed significant improvement for proprioceptive training group in proprioception test (p<0.05, I²=18%), knee extensor muscle strength (p<0.05, I²=29%), knee flexor muscle strength (p<0.05, I²=0%) and knee function score (p<0.05, I²=0%) compared with conventional training group in patients after APM.

CONCLUSION

Based on very low quality, adding proprioceptive training to conventional rehabilitation programmes might be beneficial to promote functional recovery for patients after APM. It is necessary to carry out more samples and higher quality large-scale studies to provide high evidence in the future.

PROSPERO REGISTRATION NUMBER

CRD42020213201.

Predictive Factors Associated With Short-Term Clinical Outcomes and Time to Return to Activity After Arthroscopic Partial Meniscectomy in Nonathletes

Background:

Although arthroscopic partial meniscectomy is a widely implemented surgical procedure, studies investigating the time to return to activity (RTA) are rare.

Purpose:

To explore which factors are associated with the RTA times after arthroscopic partial meniscectomy and to investigate whether those factors can also improve short-term patient-reported outcomes.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The authors reviewed the records of patients who underwent isolated partial meniscectomy in their institution from January 2017 to December 2019. Patient and injury characteristics were documented, and time to RTA was obtained via phone interview in January 2021. Pre- and postoperative outcomes were assessed with the Lysholm score and International Knee Documentation Committee (IKDC) score. The chi-square test and independent-samples t test were used to evaluate differences in outcome scores and time to RTA according to the patient and injury characteristics, and risk factors with a P value <.1 in the univariate analysis were used in the binary regression.

Results:

Included were 215 patients (87 men and 128 women; mean age, 33.7 years [range, 24-75 years]). Of these patients, 204 provided information on time to RTA (mean, 3.3 months). By 3 months postoperatively, 49.5% (101/204) of patients could perform activities without knee-related restriction; this improved to 69.6% (142/204) at 6 months and 90.2% (184/204) at 12 months. On multivariate logistic regression analysis, age (OR, 0.39; 95% CI, 0.21-1.19; P = .044) and injury duration (OR, 0.20; 95% CI, 0.19-1.07; P = .032) were significantly associated with the time to RTA. IKDC scores improved significantly from 41.2 preoperatively to 76.7 postoperatively, and in the multivariate logistic regression model, female sex (OR, 2.67; 95% CI, 1.10-6.47; P = .030), body mass index (BMI) ≥27 kg/m² (OR, 2.96; 95% CI, 1.02-8.66; P = .047), and medial meniscal tear (OR, 0.20; 95% CI, 0.04-1.00; P = .050) were associated with inferior outcome scores.

Conclusion:

Patients aged 40 years and younger who underwent partial meniscectomy surgery within 6 months after a meniscal tear were more likely to have a shorter time to RTA, and female patients with obesity (BMI ≥27 kg/m2), especially those with medial meniscal tears, tended to have inferior clinical outcomes.

Predictors of Disparities in Patient-Reported Outcomes before and after Arthroscopic Meniscectomy

The purpose of this study is to identify predictors of disparities in patient-reported outcome measures (PROMs) before and after arthroscopic meniscectomy. Knee injury and Osteoarthritis Outcome Score (KOOS) was used in this study. All patients who underwent single-knee arthroscopic meniscectomy from January 2012 to March 2018 performed by a single surgeon at an academic safety-net hospital were identified. We excluded patients who had undergone ipsilateral previous knee surgery, bilateral meniscectomy, or concomitant ligament, cartilage, or osteotomy procedures, and those with severe radiographic osteoarthritis in the operated knee, missing preoperative data, or military insurance. Data abstracted from medical records included demographics (age, sex, race, insurance type), clinical characteristics (body mass index, Charlson comorbidity index, and Kellgren-Lawrence [KL] grade), procedure codes, and KOOS assessed before and 90 days after surgery. Multivariable analyses investigated the associations between patient characteristics and the KOOS Pain, other Symptoms, and Function in activities of daily living (ADL) subscales. Among 251 eligible patients, most were female (65.5%), half were of nonwhite race (50.2%), and almost one third were insured by Medicaid (28.6%). Medicaid and black race were statistically significant (p < 0.05) predictors of worse preoperative values for all three KOOS subscales. Medicaid insurance also predicted a lower likelihood of successful surgery, defined as meeting the 10-point minimal clinically important difference, for the KOOS symptoms (p < 0.05) and KOOS ADL (p < 0.05) subscales. Compared with patients without definitive evidence of radiographic osteoarthrosis (KL grade 1), those with moderate radiographic osteoarthritis (KL grade 3) were less likely to have a successful surgical outcome (p < 0.05 for all subscales). Worse preoperative KOOS values predicted worse postoperative KOOS values (p < 0.001 for all subscales) and a lower likelihood of surgical success (p < 0.01 for all subscales). Insurance-based disparities in access to orthopaedic care for meniscus tears may explain worse preoperative PROMs and lower success rates of meniscectomy among Medicaid patients. Patients with meniscus tears and radiological and/or magnetic resonance imaging evidence of osteoarthritis should be carefully evaluated to determine the appropriateness of arthroscopic meniscectomy.

Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: Analysis of Patient Outcomes and Degenerative Joint Disease at 5 Years in the Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial

BACKGROUND

The purpose of this study was to examine the effect of debridement (CL-Deb) versus observation (CL-noDeb) of unstable chondral lesions on knee pain 5 years after arthroscopic partial meniscectomy (APM) in patients enrolled in the Chondral Lesions And Meniscus Procedures (ChAMP) Trial. Secondarily, other knee symptoms, function, general health, and the rate of additional surgery on the affected knee were examined.

METHODS

Patients aged ≥30 years who had an unstable Outerbridge grade-II, III, or IV chondral lesion when undergoing APM were randomly allocated to the CL-Deb (n = 98) or CL-noDeb (n = 92) group; ∼80% in each group completed a 5-year follow-up. Outcomes were measured preoperatively and at 5 years postoperatively, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Short Form-36 (SF-36), physical knee measurements, knee radiographs, and rate of additional knee surgery at 5 years. The primary outcome was the 5-year WOMAC pain score. Group comparisons were made using the t test for continuous outcomes and the Fisher exact test for categorical outcomes.

RESULTS

There were no significant differences between the groups with respect to the primary outcome, the WOMAC pain score (CL-Deb: 86.0 [95% confidence interval (CI): 82.9 to 89.1]) versus CL-noDeb: 88.3 [95% CI: 85.5 to 91.1]; p = 0.27), or secondary outcomes at 5 years. There were also no differences in radiographic measurements of joint-space narrowing in any compartment (medial or lateral tibiofemoral or medial, central, or lateral patellofemoral) as well as no difference in the rate of additional knee surgery within 5 years after APM between the CL-Deb and CL-noDeb groups.

CONCLUSIONS

Outcomes for the CL-Deb and CL-noDeb groups did not differ at 5 years postoperatively, suggesting that there is no long-term benefit of arthroscopic debridement of chondral lesions encountered during APM.

LEVEL OF EVIDENCE

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis

Purpose

To define the time required to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) for isolated arthroscopic partial meniscectomy (APM), and define preoperative and intraoperative factors that predict both early and late achievement of the stated metrics.

Methods

Patients who underwent isolated APM between 2014 and 2017 were retrospectively included. Patients without preoperative and 6-month patient-reported outcome measure scores, revision procedures, and significant concomitant procedures were excluded. The MCID, SCB, and PASS were calculated for knee-based patient-reported outcome measure scores using receiver operating curve analysis. Kaplan-Meier survival analysis established the time required to achieve MCID, SCB and PASS. Hazard ratios from multivariate Cox regression allowed for the isolation of demographic and intraoperative factors predictive of the delayed time required to achieve MCID, SCB and PASS.

Results

A total of 126 patients (42.86% female, age: 48.9 ± 12.4 years) were included. Overall achievement rates ranged between 73.0% and 89.7% for MCID, 43.7% and 68.2% for SCB, and 50.8% and 68.3% for PASS. Median achievement time for MCID was 5.68-5.78 months, 5.73-6.05 months for SCB and 6.54-7.72 months for PASS. Multivariate Cox regression identified older age, workers' compensation status, diabetes, and various tear types (i.e., longitudinal, transverse, bucket handle, complex) as predictors of early clinically significant outcome achievement (hazard ratio: 1.02-24.72), whereas subsequent steroid injection, higher preoperative scores and root and flap tears predicted delays in clinically significant outcome achievement (hazard ratio: 0.12-0.99).

Conclusions

The majority of patients undergoing APM achieve benefit within 6 months of surgery, with diminishing proportions at later timepoints. Important factors for consideration of the the timeline of achieving clinically significant outcome include age, diabetes, workers' compensation, preoperative score, and tear type. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving APM.

Study design

Level IV, Therapeutic Case Series.

Chondral lesions at the medial femoral condyle, meniscal degeneration, anterior cruciate ligament insufficiency, and lateral meniscal tears impair the middle-term results after arthroscopic partial meniscectomy

PURPOSE

The aim of the present study was to analyse which clinical, radiological and arthroscopic findings are able to predict the postoperative outcome after arthroscopic partial meniscectomy. Furthermore, the present study aimed to investigate the postoperative outcome after partial meniscectomy in patients with degenerative meniscal lesions.

METHODS

A total of 91 patients with a follow-up period of 34.7 ± 11.4 months after arthroscopic partial meniscectomy were included in this retrospective study. Clinical, radiological, and arthroscopic data were analysed at the time of follow-up. The multivariable linear regression analysis for postoperative outcome, based on the Western Ontario Meniscal Evaluation Tool (WOMET), included age, gender, body mass index, physical activity, presence of cartilage lesions, leg alignment, grade of radiographic osteoarthritis, location of meniscal lesions, meniscal extrusion, meniscal degeneration, presence of an anterior cruciate ligament tears as well as bone marrow lesions.

RESULTS

WOMET and WOMAC scores showed a significant improvement of 45.0 ± 48.1 points (CI 34.9-55.1; p ≤ 0.0001) and 75.1 ± 69.3 points (CI 60.6-89.6; p = 0.001) within the follow-up period. Multivariable linear regression analysis showed that poor preoperative WOMET scores (p = 0.001), presence of cartilage lesions at the medial femoral condylus (p = 0.001), meniscal degeneration (p = 0.008), the presence of an anterior cruciate ligament lesion (p = 0.005), and lateral meniscal tears (p = 0.039) were associated with worse postoperative outcomes. Patients with femoral bone marrow lesions had better outcome (p = 0.038).

CONCLUSION

Poor preoperative WOMET scores, presence of cartilage lesions at the medial femoral condylus, meniscal degeneration, concomitant anterior cruciate ligament lesions as well as lateral meniscal tears are correlated with worse postoperative outcomes after arthroscopic partial meniscectomy. Patients with femoral bone marrow lesions femoral are more likely to gain benefit from arthroscopic partial meniscectomy in the middle term. Despite justified recent restrictions in indication, arthroscopic partial meniscectomy seems to effectively reduce pain and alleviate symptoms in carefully selected patients with degenerative meniscal tears.

LEVEL OF EVIDENCE

III.

Using Patient-Reported Outcome Measurement Information System Computer Adaptive Testing Domains to Investigate the Impact of Obesity on Physical Function, Pain Interference, and Mental Health in Sports Medicine Patients

Background

While obesity has become an increasingly prevalent health concern in the United States, little emphasis has been placed on utilizing patient reported outcome measures (PROM) to investigate its impact on life from the patients’ perspective. The purpose of the study was to determine the association between patients’ body mass index (BMI) and three Patient-Reported Outcome Measurement Information System (PROMIS) computer adaptive test scores: upper extremity physical function (UE) or lower extremity physical function (PF), pain interference (PI), and depression (D).

Methods

Patients were recruited from two sports medicine orthopedic surgery clinics. PROMIS questionnaires were administered to patients arriving for their first visit. Patients were stratified into BMI groupings according to the National Institute of Health standards. Patients’ BMI, sex, race, ethnicity, and injury were determined retroactively. Data were analyzed using a Pearson correlation and a least significant difference post hoc test.

Results

A total of 833 patients completed the set of PROMIS questionnaires that were retrospectively analyzed. BMI was found to have a correlation with PROMIS-UE (R=−0.111, P<0.05), PROMIS-PF (R=−0.174, P<0.01), PROMIS-PI (R=0.224, P<0.01), and PROMIS-D (R=0.092, P<0.05). Obese patients also portrayed the worst PROMIS-UE, PROMIS-PI, and PROMIS-PF.

Conclusion

We found BMI to correlate with each PROMIS domain: negatively with PROMIS-UE, PROMIS-PF, PROMIS-D, and positively with PROMIS-PI. Additionally, overweight and obese BMI patients portrayed worse physical function and pain interference scores than their healthy group counterparts.

Should We Question the External Validity of Database Studies? A Comparative Analysis of Demographics

PURPOSE

To define the external validity of national and institutional databases for common sports medicine procedures.

METHODS

Patient demographic data including age, sex, body mass index (BMI), and 4 racial categories were aggregated between 2007 and 2016 across 2 databases for 4 common sports medicine procedures: anterior cruciate ligament reconstruction, arthroscopic rotator cuff repair (RCR), partial meniscectomy (PMx), and both arthroscopic and open shoulder stabilization. The first database of interest was a prospectively collected institutional database. The second was the National Surgical Quality Improvement Program (NSQIP) database. Two-sample t tests were performed to examine mean differences (MDs) in age and BMI, and χ² testing was used to test differences in sex and race.

RESULTS

A total of 7,019 institutional and 108,881 NSQIP patients were examined. The NSQIP cohort was significantly older (MD, 1.40 years), included more female patients (42.60% female patients vs 35.67% female patients), and showed a different racial distribution compared with the institutional data (all P < .0001). The NSQIP PMx cohort (MD, 7.38 years) was significantly older and the NSQIP RCR cohort (MD, 1.97 years) was significantly younger than their institutional counterparts (all P < .0001). The NSQIP anterior cruciate ligament reconstruction cohort (MD, 2.53) showed a greater average BMI (P < .0001). The NSQIP RCR cohort (41.8% female patients vs 33.3% female patients) and PMx cohort (46.0% female patients vs 37.9% female patients) also included more female patients. Race was distributed variably between databases for each procedure code (all P < .0001).

CONCLUSIONS

Significant differences in age, BMI, sex, and race distributions were observed between an institutional database and the NSQIP database. This study underlines the importance of defining the generalizability of database research, particularly when significant demographic differences between databases may underlie differences in postoperative outcomes.

LEVEL OF EVIDENCE

Level III, cross-sectional study.

Adipose-to-muscle area ratio at the knee is superior to BMI in predicting post-operative outcome following arthroscopic meniscectomy

PURPOSE

To determine if measurement of leg adipose tissue area by MRI is a better predictor of post-operative clinical outcome compared to body mass index (BMI) following arthroscopic meniscectomy.

METHODS

Patients that underwent an arthroscopic partial meniscectomy between 2011 and 2016 were identified and a retrospective chart review was performed. Patients with additional knee pathology other than a meniscal tear with or without associated articular cartilage injury were excluded. Leg adipose tissue and muscle area measurements at the level of the knee joint were performed for patients on their preoperative axial magnetic resonance imaging (MRI) study and adipose-to-muscle area ratio (AMR) was calculated. Correlations among AMR, BMI, and post-operative clinical outcomes were compared.

RESULTS

A total of 74 patients (32 females and 42 males) were included (mean age 50.0 years, std. dev. 12.3 years). 35 patients underwent a partial medial meniscectomy, 15 underwent a partial lateral meniscectomy, and 24 underwent both. Linear regression analysis showed that the AMR, compared to BMI, had a significantly stronger correlation to both mean post-operative Knee Injury and Osteoarthritis Outcome Score (KOOS) across all 5 subscales (KOOS₅) and Tegner Current score. Patients that had cartilage damage and concurrent chondroplasty tended to be older and have lower post-operative KOOS₅ compared to those with no cartilage damage. AMR was also significantly correlated to age and BMI.

CONCLUSIONS

The current study demonstrates that compared to BMI, leg adiposity as determined by the ratio of adipose tissue to muscle area on axial MRI (AMR), is a stronger predictor of functional outcome following meniscectomy. This suggests a role of obesity in the progression of OA beyond the increased joint forces associated with increased BMI.

LEVEL OF EVIDENCE

IV, retrospective case series.

Patient Reported Outcomes Measurement Information System Scores Are Responsive to Early Changes in Patient Outcomes Following Arthroscopic Partial Meniscectomy

PURPOSE

The purpose of this study was to test the hypothesis that Patient Reported Outcomes Measurement Information System (PROMIS) computer-adaptive testing (CAT) physical function and pain interference scores can detect early variations in postoperative outcomes following arthroscopic partial meniscectomy and to determine whether age, sex, body mass index, mechanical symptoms, duration of symptoms, and the severity of chondrosis affect these scores.

METHODS

Seventy-five patients who had undergone a partial meniscectomy between September 2015 and March 2016 and had both preoperative and postoperative PROMIS-CAT data for physical function, pain interference, and depression were included. Demographic, clinical, and surgical data including the presence of intraoperative chondral lesions were collected for statistical analysis to assess for factors that led to differences in PROMIS-CAT outcomes.

RESULTS

Preoperatively, patients had decreased physical function and increased pain interference in excess of 1 standard deviation from the general population with mean PROMIS scores of 38.5 and 63.5, respectively. At the 6-week postoperative visit, patients had significant improvements in both physical function and pain interference with mean scores of 43.4 (P < .001, SE = 0.75) and 55.5 (P < .001, SE = 0.83). Female patients had less improvement in PROMIS physical function (P = .03) and depression (P = .02) scores postoperatively compared with male patients. Patients with high-grade articular cartilage lesions had less improvement in physical function (P = .014) and pain interference (P = .010) at 6 weeks postoperative compared with patients with low grade or no chondral lesion.

CONCLUSIONS

PROMIS-CAT provides responsive outcome measures to early postoperative changes in physical function and pain following arthroscopic partial meniscectomy and has prognostic value in patient outcomes 6 weeks after procedure.

LEVEL OF EVIDENCE

Level IV case series.

How Does the Presence of Unstable Chondral Lesions Affect Patient Outcomes After Partial Meniscectomy? The ChAMP Randomized Controlled Trial

BACKGROUND

Chondral lesions are commonly encountered during arthroscopic partial meniscectomy (APM); however, it is unknown how these lesions affect postoperative outcomes.

PURPOSE

The authors compared postoperative outcomes among patients with and without unstable chondral lesions 1 year after APM.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

The authors conducted a secondary analysis of data from the ChAMP (Chondral Lesions and Meniscus Procedures) randomized controlled trial. They compared the following outcomes for patients with unstable chondral lesions that were left in situ and observed (CL-noDeb) versus patients without unstable chondral lesions (NoCL) at 1 year after APM: Western Ontario and McMaster Universities Osteoarthritis Index, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain, the Short Form Health Survey, range of motion, quadriceps circumference, and effusion. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% CIs adjusted for age, body mass index, and preoperative score (for postoperative scores).

RESULTS

Compared with the CL-noDeb group, the NoCL group had greater improvement in Western Ontario and McMaster Universities Osteoarthritis Index for pain (MD, 7.9, 95% CI: 2.7-13.1), stiffness (MD, 9.1, 95% CI: 1.9-16.3), and physical function (MD, 4.6, 95% CI: 0.1-9.0) and Knee injury and Osteoarthritis Outcome Score for pain (MD, 8.4, 95% CI: 2.7-14.0), function in sport and recreation (MD, 11, 95% CI: 3.0-19.1), and quality of life (MD, 10.4, 95% CI: 2.3-18.5). The NoCL group was less likely than the CL-noDeb group to have an effusion ( P = .02) 1 year after surgery.

CONCLUSION

Patients undergoing APM without unstable chondral lesions had better outcomes than patients with unstable chondral lesions.

Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Revision 2018

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to meniscus and articular cartilage lesions. J Orthop Sports Phys Ther. 2018;48(2):A1-A50. doi:10.2519/jospt.2018.0301.

Therapeutic efficacy of three hyaluronic acid formulations in young and middle-aged patients with early-stage meniscal injuries

[Purpose] To investigate and compare the efficacy of three hyaluronic acid formulations in patients with early-stage meniscal injuries. [Subjects and Methods] Male and female patients who were admitted to our clinic between January 2013 and December 2013, diagnosed with early-stage meniscus lesions of the knee, and given a hyaluronic acid treatment were included in this retrospective study. Patients were categorized into 3 groups according to their treatments: MONOVISC, OSTENIL PLUS, or ORTHOVISC. Scores from a Visual Analog Scale and the Western Ontario and McMaster Universities Arthritis Index were evaluated at baseline and one, three, and six months after baseline. [Results] A total of 55 patients were included in this study. Most of the patients were female (55%), and the mean age of the patients was 42.4 (± 8.1) years. Based on the pre- and post-injection data, there was significant reductions both in the Visual Analog Scale score and the Western Ontario and McMaster Universities Arthritis Index score after the injections for all groups. According to intergroup comparisons, no significant difference was observed in terms of efficacy. [Conclusion] Three hyaluronic acid formulations produced a similar efficacy in patients with meniscal injuries, and further studies are needed to evaluate long-term results.

A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery

Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial.

Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up

PURPOSE

To determine which specific factors influence the improvements in function and pain at the first year following arthroscopic partial meniscectomy.

METHODS

Between 2012 and 2013, patients who had arthroscopic partial meniscectomy were included (n = 201) and followed prospectively before surgery and at 12 months. Multivariable stepwise analysis included preoperative variables (age, gender, limb side, height, weight, body mass index, comorbidities, smoking, Tegner activity scale, Lysholm knee score, preceding injury and duration of preoperative symptoms) and arthroscopic findings (degree of cartilage lesions, medial or lateral meniscus involvement, type of meniscal tear and concomitant cruciate tear). The Lysholm clinical score at the last follow-up and the time interval for substantial pain relief was modelled as a function of the above predictor variables.

RESULTS

At the last follow-up, the mean Lysholm score improved by 14.6 points (95 % CI 10.4-18.8, P < 0.001), from 68.0 ± 16.1 to 82.6 ± 19.6 points and 153 (76 %) patients declared they were satisfied to have had the operation. The mean time interval for substantial pain relief was 3.5 ± 1.5 months. Females and patients with lower preoperative Lysholm score were correlated with lower post-operative Lysholm score, while females and patients with lateral meniscal tears (compared to medial meniscal tears) were correlated with longer recovery.

CONCLUSIONS

Arthroscopic partial meniscectomy improved pain and function at the first year post-operatively. Female gender, lateral meniscal tear and less favourable preoperative function were relatively correlated to worse post-operative function and longer rehabilitation time.

LEVEL OF EVIDENCE

IV.

Correlation between body mass index and chondral lesions in isolated medial meniscus tears

BACKGROUND

Chondral lesions of the knee are commonly found during arthroscopic partial meniscectomy. The literature advises against arthroscopic medial meniscectomy in the presence of advanced chondral derangement because of unfavorable outcome. Recent studies have shown an association between obesity and chondropathy in patients with meniscal tears. The aim of this study was to assess whether body mass index (BMI) correlates with the severity of chondral lesions in patients with isolated medial meniscus tears (i.e. without ligamentous or lateral meniscal injury).

MATERIALS AND METHODS

837 knee arthroscopies were performed in a regional referral center of arthroscopic surgery between January 2011 and December 2012. Of these 168 (109 males, 59 females) patients with no axial knee deformity and no radiological signs of osteoarthritis who have had arthroscopic debridement for isolated torn medial meniscus were included in the study. The correlation between different demographic factors and the level of chondral damage reported at surgery was evaluated. The mean age of patient was 50 years (range 13-82 years) and an average BMI was 28.2 kg/m(2) (range17.5-42.5 kg/m(2)).

RESULTS

Overall, regression analysis showed both age and BMI to be linearly correlated to chondral score (r = 0.53, P < 0.04); however, there were no advanced chondral lesions found in patients younger than 40 years of age and all severe lesions were at age 50 years or more. Therefore, further analysis was performed for age subgroups: patients were grouped as younger than 40, between the age of 40 and 50 (middle age) and older than 50 years. The BMI was linearly correlated to the severity of chondral score exclusively in the middle aged group (i.e. 40-50 years old). There was no correlation between activity level and chondral damage. Women had worse chondral lesions than men in all age groups.

CONCLUSION

Higher BMI in middle aged patients with isolated medial meniscus tears and unremarkable radiographs may predict more advanced chondral lesions at arthroscopy.

Does body mass index affect outcomes of ambulatory knee and shoulder surgery?

PURPOSE

Obesity is highly prevalent among patients with knee and shoulder injuries and is associated with greater odds of surgical treatment for these injuries. The purpose of this systematic review was to summarize the literature that has examined the association between body mass index (BMI) and outcomes of ambulatory knee and shoulder surgery.

METHODS

A literature search of PubMed and Medline was conducted up to December 2013. Studies that examined the association between BMI and outcomes after ambulatory knee and shoulder surgery (arthroscopy, repairs, and reconstructions) were included. Outcomes included postoperative functional scores, clinical scores, and complications.

RESULTS

Eighteen studies were included in this review; 13 involved knee surgery and 5 involved shoulder surgery. Seven knee studies and 2 shoulder studies found increased BMI to be associated with worse postoperative outcomes, whereas the remaining 9 studies did not find an association. Increased BMI was associated with worse clinical scores and less patient satisfaction after arthroscopic meniscectomy or debridement, and with worse clinical scores and lower activity levels after anterior cruciate ligament (ACL) reconstruction. It was also associated with worse clinical scores and a longer hospital stay after rotator cuff repair and with longer time to return to work after subacromial decompression. Six studies examined the association between BMI and complications, but all reported null findings.

CONCLUSIONS

There is a lack of consensus in the literature regarding the association between BMI and ambulatory knee and shoulder surgery. Several factors may have contributed to contradictory findings, including variation in measuring and classifying anthropometry, postoperative outcomes, and follow-up time.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I, III, and IV studies.

Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear

BACKGROUND

Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.

METHODS

We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure.

RESULTS

In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, -1.6 points; 95% confidence interval [CI], -7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, -2.5 points; 95% CI, -9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, -0.1; 95% CI, -0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partial-meniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively).

CONCLUSIONS

In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.).

Knee Arthroscopy Cohort Southern Denmark (KACS): protocol for a prospective cohort study

BACKGROUND

Meniscus surgery is a high-volume surgery carried out on 1 million patients annually in the USA. The procedure is conducted on an outpatient basis and the patients leave the hospital a few hours after surgery. A critical oversight of previous studies is their failure to account for the type of meniscal tears. Meniscus tears can be categorised as traumatic or non-traumatic. Traumatic tears (TT) are usually observed in younger, more active individuals in an otherwise 'healthy' meniscus and joint. Non-traumatic tears (NTT) (ie, degenerative tears) are typically observed in the middle-aged (35-55 years) and older population but the aetiology is largely unclear. Knowledge about the potential difference of the effect of arthroscopic meniscus surgery on patient symptoms between patients with traumatic and NTT is sparse. Furthermore, little is known about the natural time course of patient perceived pain, function and quality of life after meniscus surgery and factors affecting these outcomes. The aim of this prospective cohort study is to investigate the natural time course of patient-reported outcomes in patients undergoing meniscus surgery, with particular emphasis on the role of type of symptom onset.

METHODS/DESIGN

This prospective cohort study enrol patients assigned for meniscus surgery. At the baseline (PRE surgery), patient characteristics are assessed using an email-based questionnaire also comprising several validated questionnaires assessing general health, knee-specific characteristics and patient's expectations of the surgery. Follow-up will be conducted at 12 and 52 weeks after meniscus surgery. The major outcomes will be differences in changes, from before to 52 weeks after surgery, in each of the five domains on the Knee injury and Osteoarthritis Outcome Score (KOOS) between patients undergoing surgery for traumatic compared with non-traumatic meniscus tears.

DISSEMINATION

The study findings will be disseminated in peer-reviewed journals and presented at national and international conferences.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Identifier: NCT01871272.

The effectiveness of postoperative physical therapy treatment in patients who have undergone arthroscopic partial meniscectomy: systematic review with meta-analysis

STUDY DESIGN

Systematic review with meta-analysis.

OBJECTIVES

To evaluate the effectiveness of postoperative physical therapy treatment for patients who have undergone arthroscopic partial meniscectomy.

BACKGROUND

There is no consensus on which treatment is best for patients post meniscectomy.

METHODS

A search for articles published from 1950 to March 2013 was conducted in the MEDLINE, Embase, CINAHL, LILACS, SciELO, IBECS, Scopus, Web of Science, PEDro, Academic Search Premier, and Cochrane Central Register of Controlled Trials databases. The key words were physiotherapy, physical therapy modalities, exercise therapy, rehabilitation, knee, placebo, groups, tibial meniscus, meniscus, arthroscopy, meniscectomy, partial meniscectomy, randomized controlled trial, controlled clinical trial, randomized, systematic review, and meta-analysis.

RESULTS

Eighteen randomized controlled trials were included in the review, 6 of which were included in the meta-analysis. Outpatient physical therapy plus a home exercise program, compared to a home program alone, improved function compared to a home program alone (mean difference, 10.3; 95% confidence interval: 1.3, 19.3; P = .02) and knee flexion range of motion (mean difference, 9.1; 95% confidence interval: 3.7, 14.5; P = .0009). Inpatient physical therapy alone compared to inpatient plus outpatient physical therapy reduced the likelihood of effusion (odds ratio = 0.25; 95% confidence interval: 0.10, 0.61; P = .003).

CONCLUSION

Physical therapy associated with home exercises seems to be effective in improving patient-reported knee function and range of motion in patients post-arthroscopic meniscectomy, although the included randomized controlled trials were classified from moderate to high risk of bias and should be interpreted with caution.

LEVEL OF EVIDENCE

Therapy, level 1a-.

Complications in brief: Arthroscopic partial meniscectomy

Arthroscopic partial meniscectomy can be complicated by excessive resection, damage to articular cartilage, neurovascular injury, persistent drainage from portals, and infection; the procedure can be rendered more difficult, and the outcome less certain, if the surgeon fails to recognize concomitant injuries, malpositions the portals, or misidentifies the components of a meniscus tear. We review the problems that can occur as a result of errors made before, during, and after surgery.

Finnish Degenerative Meniscal Lesion Study (FIDELITY): a protocol for a randomised, placebo surgery controlled trial on the efficacy of arthroscopic partial meniscectomy for patients with degenerative meniscus injury with a novel 'RCT within-a-cohort' study design

INTRODUCTION

Arthroscopic partial meniscectomy (APM) to treat degenerative meniscus injury is the most common orthopaedic procedure. However, valid evidence of the efficacy of APM is lacking. Controlling for the placebo effect of any medical intervention is important, but seems particularly pertinent for the assessment of APM, as the symptoms commonly attributed to a degenerative meniscal injury (medial joint line symptoms and perceived disability) are subjective and display considerable fluctuation, and accordingly difficult to gauge objectively.

METHODS AND ANALYSIS

A multicentre, parallel randomised, placebo surgery controlled trial is being carried out to assess the efficacy of APM for patients from 35 to 65 years of age with a degenerative meniscus injury. Patients with degenerative medial meniscus tear and medial joint line symptoms, without clinical or radiographic osteoarthritis of the index knee, were enrolled and then randomly assigned (1 : 1) to either APM or diagnostic arthroscopy (placebo surgery). Patients are followed up for 12 months. According to the prior power calculation, 140 patients were randomised. The two randomised patient groups will be compared at 12 months with intention-to-treat analysis. To safeguard against bias, patients, healthcare providers, data collectors, data analysts, outcome adjudicators and the researchers interpreting the findings will be blind to the patients' interventions (APM/placebo). Primary outcomes are Lysholm knee score (a generic knee instrument), knee pain (using a numerical rating scale), and WOMET score (a disease-specific, health-related quality of life index). The secondary outcome is 15D (a generic quality of life instrument). Further, in one of the five centres recruiting patients for the randomised controlled trial (RCT), all patients scheduled for knee arthroscopy due to a degenerative meniscus injury are prospectively followed up using the same protocol as in the RCT to provide an external validation cohort. In this article, we present and discuss our study design, focusing particularly on the internal and external validity of our trial and the ethics of carrying out a placebo surgery controlled trial.

ETHICS AND DISSEMINATION

The protocol has been approved by the institutional review board of the Pirkanmaa Hospital District and the trial has been duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations.

TRIAL REGISTRATION

ClinicalTrials.gov, number NCT00549172.

Does obesity negatively affect the functional results of arthroscopic partial meniscectomy? A retrospective cohort study

PURPOSE

The purpose of this study was to evaluate the impact of body mass index (BMI) on early functional results of patients who undergo isolated partial meniscectomy.

METHODS

The functional results for 1,090 patients who underwent partial meniscectomy, in 2 different orthopaedic clinics, were evaluated retrospectively. The study includes cases with arthroscopic partial meniscectomy for isolated meniscal tears; patients with concomitant knee pathology were excluded. Three hundred forty-one (31%) patients with isolated lateral meniscal tears, 628 (58%) patients with isolated medial meniscal tears, and 121 (11%) patients with both medial and lateral meniscal tears underwent arthroscopic partial meniscectomy. We divided these patients into 3 subgroups on the basis of their BMI; <26, between 26 and 30, ≥30. Preoperative functional results were compared with 1-year postoperative follow-up results using the International Knee Documentation Committee (IKDC),(26) Lysholm Knee Scale,(27) and Oxford Scoring System(28) scores.

RESULTS

According to all 3 knee scales, age, side of lesion, and tear type had no effect on functional outcome. When compared with the group with BMI <26, the patients with BMI between 26 and 30 and the patients with BMI ≥30 had significantly worse outcomes as measured by the IKDC, Oxford Scoring System, and Lysholm Knee Scale scores. Patients with BMI between 26 and 30 and ≥30 did not have significantly different functional outcomes.

CONCLUSIONS

Short-term outcomes after arthroscopic partial menisectomy reflect significant improvement in subjective outcome. However, patients with moderate or significant obesity (BMI >26) have inferior short-term outcomes compared with nonobese patients.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

The prevalence of articular cartilage changes in the knee joint in patients undergoing arthroscopy for meniscal pathology

PURPOSE

The purposes of this study were to evaluate the prevalence of articular cartilage changes in the knee joint and to analyze predictive factors for these changes in patients undergoing arthroscopy for meniscal pathology.

METHODS

Between March 2005 and June 2009, 1,010 patients underwent arthroscopic meniscectomy or meniscal repair by the senior author. During surgery, a precise diagram was used to carefully note the presence, location, size, and Outerbridge grade of changes to the articular surfaces of the knee joint. The prevalence of articular cartilage changes was calculated for 6 age groups: younger than 20 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, and 60 years or older. Demographic data including gender, ethnicity, smoking status, and body mass index (BMI) were acquired from patient charts.

RESULTS

Overall, 48% of patients showed changes to the medial compartment, 25% to the lateral compartment, and 45% to the patellofemoral compartment. Eighty-five percent of patients aged 50 to 59 years and 86% of patients aged 60 years or older showed articular cartilage changes to at least 1 knee compartment. In contrast, only 13% of patients aged younger than 20 years and 32% of patients aged 20 to 29 years showed changes to at least 1 compartment. A significant relation was found between age and the development of articular cartilage changes in each of the 3 compartments (P < .0001). BMI was also significantly related to articular cartilage changes in the medial and patellofemoral compartments (P < .0001) but not the lateral compartment (P = .08).

CONCLUSIONS

This study shows a high prevalence of articular cartilage damage as defined by the Outerbridge classification in patients undergoing arthroscopic surgery for meniscal pathology. Risk factors that correlate with articular cartilage damage include increasing age, elevated BMI, medial compartment pathology, and knee contractures.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

Efficacy of electromyographic biofeedback and electrical stimulation following arthroscopic partial meniscectomy: a randomized controlled trial

OBJECTIVE

To compare the effectiveness of electromyographic biofeedback training and electrical stimulation therapy for rehabilitation following arthroscopic partial meniscectomy.

DESIGN

Randomized, prospective, controlled single-blind trial.

SETTING

Department of physical medicine and rehabilitation, university hospital.

SUBJECTS

Forty-five patients who had undergone surgery for arthroscopic partial meniscectomy were randomly divided into three groups with 15 patients in each group.

INTERVENTIONS

The control group had home exercise, the second and third groups received electromyographic biofeedback training or electrical stimulation therapy to quadriceps muscle in addition to home exercise.

MAIN MEASURES

The patients were evaluated for: visual analogue scale, gait velocity (m/s), time using a walking aid after surgery, Lysholm Knee Scoring Scale score, knee flexion-extension angle, maximum and average contraction powers of vastus medialis obliquus and vastus lateralis muscles on the day before the operation and two and six weeks after.

RESULTS

The time using a walking aid was 8.3 ± 8.0, 1.5 ± 2.5 and 4.5 ± 5.5 days, respectively, for the home exercise, electromyographic biofeedback training and electrical stimulation groups, and significantly shorter in the electromyographic biofeedback training than in the home exercise group (P < 0.017). While significant progress was detected in Lysholm Knee Scoring Scale score in the second and sixth postoperative weeks compared to the preoperative within-group evaluation for each of the three groups (P < 0.017), there was significant difference in Lysholm Knee Scoring Scale in the second postoperative week in favour of electromyographic biofeedback training compared to home exercise (P < 0.017). There were significant differences in vastus medialis obliquus average and vastus lateralis maximum and average contractions in favour of electromyographic biofeedback compared to home exercise and electrical stimulation in the second postoperative week (P < 0.017).

CONCLUSIONS

The addition of electromyographic biofeedback training to a conventional exercise programme following arthroscopic partial meniscectomy helps to speed up the rehabilitation process.

Does arthroscopic partial meniscectomy result in knee osteoarthritis? A systematic review with a minimum of 8 years' follow-up

PURPOSE

Our purpose is to test the hypothesis that arthroscopic partial meniscectomy results in knee osteoarthritis at long-term follow-up.

METHODS

We systematically reviewed PubMed search terms "meniscus AND arthritis AND knee" and "meniscectomy AND arthritis AND knee" and included English-language, Levels I to IV evidence studies reporting either radiographic or clinical osteoarthritis outcome measures with a minimum of 8 years' follow-up after partial arthroscopic meniscectomy.

RESULTS

Five studies met the inclusion criteria. All reported both radiographic and clinical measures. All studies compared the normal, contralateral knee as a radiographic control, but none included a clinical control group. Follow-up ranged from 8 to 16 years. In all studies operative knees showed a statistically significant incidence of radiographic signs of osteoarthritis compared with control knees. However, clinical symptoms of osteoarthritis were not observed. Furthermore, clinical outcomes did not correlate with radiographic findings.

DISCUSSION

Our results show that radiographic signs of osteoarthritis are significant at 8 to 16 years' follow-up after knee arthroscopic partial meniscectomy, but clinical symptoms of knee arthritis were not observed. Limitations include absence of clinical control groups and heterogeneity of reported outcome measures. Future research of higher levels of evidence and with longer-term follow-up is required to determine whether the radiographic signs ultimately foreshadow clinical symptoms in patients after arthroscopic partial meniscectomy.

CONCLUSIONS

Radiographic signs of osteoarthritis are significant at 8 to 16 years' follow-up after knee arthroscopic partial meniscectomy, but clinical symptoms of knee arthritis are not significant.

LEVEL OF EVIDENCE

Systematic review of Level IV clinical evidence and Levels II and III radiographic evidence.

Muscle activations to stabilize the knee following arthroscopic partial meniscectomy

BACKGROUND

Arthroscopic partial meniscectomy patients are at increased risk of developing knee osteoarthritis. This population, particularly those with weaker quadriceps, have larger-than-normal knee adduction moments, which tend to load the medial tibiofemoral joint. Larger knee adduction moments predict progression of knee osteoarthritis and may contribute to the increased risk in meniscectomy patients. Increased muscle activity to support these large moments may further elevate articular loads. We examined a) the muscle activity while walking in a meniscectomy and control population, and b) the relationship between knee strength and muscle activity.

METHODS

Gait patterns and knee extension strength were assessed in 89 male arthroscopic partial meniscectomy patients and 30 age-matched healthy controls. Surface electromyography was recorded during walking from ten muscles that cross the knee.

FINDINGS

Compared to controls, the meniscectomy group displayed greater muscle activity while walking, with increased hamstrings activation, yet no difference in directed co-contraction. While controlling for age, no differences were found between meniscectomy subjects with weak and normal knee extension strength, in hamstrings activity, quadriceps activity or directed co-contraction.

INTERPRETATION

The generalised increase in non-directed muscle activity in the meniscectomy group may provide enhanced muscular support of larger-than-normal knee adduction moments. Higher levels of antagonist co-contraction may increase muscle forces and, subsequently, joint articular loads, contributing to the increased risk of developing knee osteoarthritis following arthroscopic partial meniscectomy.

What factors influence long-term survivorship after hip arthroscopy?

BACKGROUND

Hip arthroscopy is an evolving procedure. One small study suggested that a low modified Harris hip score and arthritis at the time of surgery were predictors of poor prognosis.

QUESTIONS/PURPOSES

We therefore intended to confirm those findings with a large patient cohort to (1) determine the long-term nonarthritic hip score; (2) determine survivorship; (3) identify risk factors that increase the likelihood of THA; and (4) use those factors to create a usable risk assessment algorithm.

PATIENTS AND METHODS

We retrospectively reviewed 324 patients (340 hips) who underwent arthroscopy for pain and/or catching. Of these, 106 patients (111 hips or 33%) had a minimum followup of 10 years (mean, 13 years; range, 10-20 years). The average age was 39 years (± 13) with 47 men and 59 women. We recorded patient age, gender, acetabular and femoral Outerbridge grade at surgery, and the presence of a labral tear. Followup consisted of a nonarthritic hip score or the date of a subsequent THA. We determined survivorship with the end point of THA for the acetabular and femoral Outerbridge grades.

RESULTS

Overall survivorship among the 111 hips was 63% at 10 years. The average nonarthritic hip score for non-THA patients was 87.3 (± 12.1). Survivorship was greater for acetabular and femoral Outerbridge grades normal through II. Age at arthroscopy and Outerbridge grades independently predicted eventual THA. Gender and the presence of a labral tear did not influence long-term survivorship.

CONCLUSIONS

The long-term survivorship of labral tears with low-grade cartilage damage indicates hip arthroscopy is reasonable for treating labral tears.

LEVEL OF EVIDENCE

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Recovery after third-molar surgery: the effects of age and sex

INTRODUCTION

In this study, we assessed the effects of age and sex on quality-of-life recovery after third-molar surgery.

METHODS

Healthy subjects scheduled for removal of third molars were recruited at multiple sites for this study. Each patient was given a condition-specific instrument to be completed each postsurgery day for 14 days. Lifestyle and oral-function recovery were assessed by using a 5-point Likert-type scale. Recovery was defined as the number of days until the patient reported no or little trouble. Recovery from pain was defined as the number of days until no medications were taken. For each quality-of-life item, a Cox regression analysis was performed to assess the effects of age and sex on recovery after controlling for surgical-procedure variables.

RESULTS

Nine hundred fifty-eight subjects treated at 9 academic centers and 12 community practices were enrolled. Except for ability to open the mouth, recovery for all quality-of-life items for those 21 years or older significantly (P < 0.02) lagged behind recovery for younger subjects. Recovery for female subjects was significantly longer than for male subjects for all outcomes (P < 0.01).

CONCLUSIONS

Patients older than 21 and those who are female should be informed before removal of all 4 third molars that their oral function, lifestyle, and pain recovery will be prolonged compared with those who are younger and male.

Lateral meniscus lesions on stable knee: a prospective multicenter study

INTRODUCTION

The present prospective multicenter study sought to analyze immediate and short-term (6 months) course following lateral meniscus lesion surgery.

MATERIAL AND METHODS

Between 2007 and 2008, 104 lateral meniscus lesions on stable knee were recruited prospectively in 10 centers. Lesion type and topography were recorded and patients were assessed by Knee Osteoarthritis Outcome Score (KOOS) and subjective and objective International Knee Documentation Committee (IKDC) scores, preoperatively and at 6 months' FU. Mean age was 37 years, with a large preponderance of male patients.

RESULTS

Lesion topography, type and management were inventoried for all patients (n=104). A majority of lesions were located in the mid-body segment. Conservative treatment (meniscal suture) was applied in a third of cases. Fifty-six patients (54%) could be analyzed at end of FU on the various assessment scores. At 6 months, patients had recovered their preoperative activity level on IKDC. Twenty-two percent, however, experienced persistent pain or reduced range of motion and 12% of postoperative courses were considered difficult.

DISCUSSION

Lateral and medial meniscal lesions differ in topography, the latter occurring less often in the anterior segment. Only 30% of patients were able to resume light physical activity on the IKDC scale at 1 month: 6 months appear to be necessary for patients operated on for a lateral meniscal lesion to recover their preoperative level of activity.

Mood and attitude predict pain outcomes following arthroscopic knee surgery

BACKGROUND

Decreased pain represents a clinically important outcome following arthroscopic knee surgery. However, little is known about preoperative mood and attitudinal factors and their potential relationship with pain outcomes.

PURPOSE

This prospective, longitudinal study investigated the influence of preoperative depression, stress, and optimism on pain severity and interference with functioning, controlling for relevant demographic and clinical factors 1 year postoperatively.

METHODS

Participants (N = 180, mean age = 48.2 years) completed scales assessing pain severity and interference both preoperatively and postoperatively. Demographics, depression, stress, optimism, and body mass index were assessed preoperatively. Physicians assessed extent of knee osteoarthritis during surgery.

RESULTS

Hierarchical regression analyses controlling for relevant demographic and clinical variables revealed that optimism and stress were significant predictors of pain severity at 1 year but not pain interference. Extent of osteoarthritis predicted pain interference.

CONCLUSIONS

These findings support that optimism and stress are important predictors of patient-rated pain severity. They do not, however, predict the extent to which pain interferes with daily functioning.