Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery. Pihl, K., Ensor, J., Peat, G., Englund, M., Lohmander, S., Jørgensen, U., Nissen, N., Fristed, J. V., & Thorlund, J. B. British journal of sports medicine, 54(1):13–22, January, 2020. Place: England![Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery. [link]](https://bibbase.org/img/filetypes/link.svg "link")
Paper doi abstract bibtex BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS(4)) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS(4) change score constitutes improvement. Prognostic performance was assessed using R(2) statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS(4). The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R(2)=0.162, optimism adjusted R(2)=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery. TRIAL REGISTRATION NUMBER: NCT01871272.
@article{pihl_wild_2020,
title = {Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery.},
volume = {54},
copyright = {© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.},
issn = {1473-0480 0306-3674},
url = {https://doi.org/10.1136/bjsports-2018-100321},
doi = {10.1136/bjsports-2018-100321},
abstract = {BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS: We included 641 patients (age 48.7 years (SD 13), 56\% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS(4)) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS(4) change score constitutes improvement. Prognostic performance was assessed using R(2) statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS(4). The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R(2)=0.162, optimism adjusted R(2)=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery. TRIAL REGISTRATION NUMBER: NCT01871272.},
language = {eng},
number = {1},
journal = {British journal of sports medicine},
author = {Pihl, Kenneth and Ensor, Joie and Peat, George and Englund, Martin and Lohmander, Stefan and Jørgensen, Uffe and Nissen, Nis and Fristed, Jakob Vium and Thorlund, Jonas Bloch},
month = jan,
year = {2020},
pmid = {31186258},
note = {Place: England},
keywords = {*Meniscectomy/adverse effects, *Patient Reported Outcome Measures, Adolescent, Adult, Aged, Denmark, Female, Follow-Up Studies, Humans, Logistic Models, Male, Meniscectomy, Middle Aged, Patient Reported Outcome Measures, Postoperative Complications, Prospective Studies, Tibial Meniscus Injuries, Tibial Meniscus Injuries/*surgery, Young Adult, arthroscopy, knee, meniscus, patient-reported outcomes, prognosis},
pages = {13--22},
}
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Published by BMJ.","issn":"1473-0480 0306-3674","url":"https://doi.org/10.1136/bjsports-2018-100321","doi":"10.1136/bjsports-2018-100321","abstract":"BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS: We included 641 patients (age 48.7 years (SD 13), 56% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS(4)) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS(4) change score constitutes improvement. Prognostic performance was assessed using R(2) statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS(4). The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R(2)=0.162, optimism adjusted R(2)=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). CONCLUSION: Despite combining a large number of preoperative factors presumed clinically relevant, change in patient-reported outcome 1 year following meniscal surgery was not predictable. This essentially quashes the existence of 'subgroups' with certain characteristics having a particularly favourable outcome after meniscal surgery. TRIAL REGISTRATION NUMBER: NCT01871272.","language":"eng","number":"1","journal":"British journal of sports medicine","author":[{"propositions":[],"lastnames":["Pihl"],"firstnames":["Kenneth"],"suffixes":[]},{"propositions":[],"lastnames":["Ensor"],"firstnames":["Joie"],"suffixes":[]},{"propositions":[],"lastnames":["Peat"],"firstnames":["George"],"suffixes":[]},{"propositions":[],"lastnames":["Englund"],"firstnames":["Martin"],"suffixes":[]},{"propositions":[],"lastnames":["Lohmander"],"firstnames":["Stefan"],"suffixes":[]},{"propositions":[],"lastnames":["Jørgensen"],"firstnames":["Uffe"],"suffixes":[]},{"propositions":[],"lastnames":["Nissen"],"firstnames":["Nis"],"suffixes":[]},{"propositions":[],"lastnames":["Fristed"],"firstnames":["Jakob","Vium"],"suffixes":[]},{"propositions":[],"lastnames":["Thorlund"],"firstnames":["Jonas","Bloch"],"suffixes":[]}],"month":"January","year":"2020","pmid":"31186258","note":"Place: England","keywords":"*Meniscectomy/adverse effects, *Patient Reported Outcome Measures, Adolescent, Adult, Aged, Denmark, Female, Follow-Up Studies, Humans, Logistic Models, Male, Meniscectomy, Middle Aged, Patient Reported Outcome Measures, Postoperative Complications, Prospective Studies, Tibial Meniscus Injuries, Tibial Meniscus Injuries/*surgery, Young Adult, arthroscopy, knee, meniscus, patient-reported outcomes, prognosis","pages":"13–22","bibtex":"@article{pihl_wild_2020,\n\ttitle = {Wild goose chase - no predictable patient subgroups benefit from meniscal surgery: patient-reported outcomes of 641 patients 1 year after surgery.},\n\tvolume = {54},\n\tcopyright = {© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.},\n\tissn = {1473-0480 0306-3674},\n\turl = {https://doi.org/10.1136/bjsports-2018-100321},\n\tdoi = {10.1136/bjsports-2018-100321},\n\tabstract = {BACKGROUND: Despite absence of evidence of a clinical benefit of arthroscopic partial meniscectomy (APM), many surgeons claim that subgroups of patients benefit from APM. OBJECTIVE: We developed a prognostic model predicting change in patient-reported outcome 1 year following arthroscopic meniscal surgery to identify such subgroups. METHODS: We included 641 patients (age 48.7 years (SD 13), 56\\% men) undergoing arthroscopic meniscal surgery from the Knee Arthroscopy Cohort Southern Denmark. 18 preoperative factors identified from literature and/or orthopaedic surgeons (patient demographics, medical history, symptom onset and duration, knee-related symptoms, etc) were combined in a multivariable linear regression model. The outcome was change in Knee injury and Osteoarthritis Outcome Score (KOOS(4)) (average score of 4 of 5 KOOS subscales excluding the activities of daily living subscale) from presurgery to 52 weeks after surgery. A positive KOOS(4) change score constitutes improvement. Prognostic performance was assessed using R(2) statistics and calibration plots and was internally validated by adjusting for optimism using 1000 bootstrap samples. RESULTS: Patients improved on average 18.6 (SD 19.7, range -38.0 to 87.8) in KOOS(4). The strongest prognostic factors for improvement were (1) no previous meniscal surgery on index knee and (2) more severe preoperative knee-related symptoms. The model's overall predictive performance was low (apparent R(2)=0.162, optimism adjusted R(2)=0.080) and it showed poor calibration (calibration-in-the-large=0.205, calibration slope=0.772). 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