Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears: comparative prospective cohort study.
OBJECTIVE
To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears.


METHODS
Comparative prospective cohort study.


METHODS
Four public orthopaedic departments in the Region of Southern Denmark. Participants were recruited between 1 February 2013 and 31 January 2014, and at one of the original four hospitals from 1 February 2014 to 31 January 2015.


METHODS
Individuals selected from Knee Arthroscopy Cohort Southern Denmark, aged 18-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset).


METHODS
Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information on knee pathology. Patient reported outcomes were recorded via online questionnaires.


METHODS
Primary outcome was the average between-group difference in change on four of five subscales of the knee injury and osteoarthritis outcome score (KOOS). The four subscales covered pain, symptoms, sport and recreational function, and quality of life (KOOS4). A 95% confidence interval excluding differences greater than 10 KOOS points between groups was interpreted as absence of a clinically meaningful difference. Analyses adjusted for age, sex, and body mass index.


RESULTS
397 eligible adults (42% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically, participants with degenerative meniscal tears had a significantly larger improvement in KOOS4scores than those with traumatic tears (adjusted between-group difference -5.1 (95% confidence interval -8.9 to -1.3); P=0.008). In the analysis including KOOS4score at all time points, a significant time-by-group interaction was observed in both the unadjusted (P=0.025) and adjusted analysis (P=0.024), indicating better self-reported outcomes in participants with degenerative tears. However, the difference between groups was at no time point considered clinically meaningful.


CONCLUSIONS
These results question the current tenet that patients with traumatic meniscal tears experience greater improvements in patient reported outcomes after arthroscopic partial meniscectomy than patients with degenerative tears.Trial registration ClinicalTrials.gov identifier NCT01871272.
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark jthorlund@health.sdu.dk.
Jonas Bloch
JB
Thorlund
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden.|Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA.
Martin
M
Englund
Musculoskeletal Statistics Unit, Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Robin
R
Christensen
Department of Orthopedics, Lillebaelt Hospital, Kolding, Denmark.
Nis
N
Nissen
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Kenneth
K
Pihl
Department of Orthopedics and Traumatology, Odense University Hospital, Odense, Denmark.
Uffe
U
Jørgensen
Department of Orthopedics, Lillebaelt Hospital, Vejle, Denmark.
Jeppe
J
Schjerning
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden.
L Stefan
LS
Lohmander
D000293:Adolescent; D000328:Adult; D001182:Arthroscopy; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007718:Knee Injuries / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D000072600:Meniscus / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology / Q000601:surgery*; D000071066:Patient Reported Outcome Measures; D011446:Prospective Studies; D017211:Treatment Failure; D055815:Young Adult