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- Pihl, Kenneth, et al.
(author)
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Association of specific meniscal pathologies and other structural pathologies with self-reported mechanical symptoms : A cross-sectional study of 566 patients undergoing meniscal surgery
- 2019
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In: Journal of Science and Medicine in Sport. - : Elsevier BV. - 1440-2440. ; 22:2, s. 151-157
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Journal article (peer-reviewed)abstract
- Objectives: We explored associations between specific meniscal pathologies and other concurrent structural knee pathologies with presence of self-reported mechanical symptoms in patients undergoing meniscal surgery. Design: Cross-sectional study. Methods: We included patients undergoing surgery for a meniscal tear from Knee Arthroscopy Cohort Southern Denmark (KACS). Pre-surgery, patients completed online questionnaires including self-reported presence of mechanical symptoms. At arthroscopy, surgeons recorded information about specific meniscal pathologies and other concurrent structural knee pathologies. Relative risks (RR) were estimated to assess associations between specific meniscal pathologies and other structural knee pathologies with preoperative mechanical symptoms from multivariable logistic regression. Results: 566 of 641 patients (mean age 48.6[SD 12.9] years, 57% men) with complete data were included. 386 (68%) patients reported mechanical symptoms of knee catching/locking and/or extension deficit. Most evaluated joint pathologies were not associated with mechanical symptoms of any kind with RRs close to 1.0. Meniscal tears involving both the posterior and anterior horn (n = 22) were associated with knee catching/locking (RR: 1.49[95%CI:1.15–1.93]), and a tear in both menisci (n = 49) was associated with extension deficit of the knee (RR: 1.32[95%CI:1.01–1.73]). A partial (n = 29) and total ACL rupture (n = 37) were each associated with extension deficit (RR: 1.83[95%CI:1.47–2.28] and RR: 1.44[95%CI:1.05–1.98], respectively). Conclusions: Limited associations between specific meniscal pathology and other concurrent knee joint pathologies with presence of self-reported mechanical symptoms were found in patients undergoing meniscal surgery. The findings question the clinical importance of mechanical symptoms as an indicator for arthroscopy for specific meniscal tears with the specific aim to relieve such symptoms.
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| 2. |
- Pihl, Kenneth, et al.
(author)
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Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear
- 2017
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In: Acta Orthopaedica. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 88:1, s. 90-95
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Journal article (peer-reviewed)abstract
- Background and purpose — Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients’ characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods — 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18–77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results — 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation — Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.
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| 3. |
- Thorlund, Jonas Bloch, et al.
(author)
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Knee Arthroscopy Cohort Southern Denmark (KACS): protocol for a prospective cohort study
- 2013
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In: BMJ Open. - : BMJ. - 2044-6055. ; 3:10, s. 003399-003399
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Journal article (peer-reviewed)abstract
- 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 (35-55years) 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 52weeks after meniscus surgery. The major outcomes will be differences in changes, from before to 52weeks 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.
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| 4. |
- Thorlund, Jonas Bloch, et al.
(author)
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Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears : comparative prospective cohort study
- 2017
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In: BMJ. - : BMJ. - 0959-8138 .- 1756-1833. ; 356
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Journal article (peer-reviewed)abstract
- OBJECTIVES: 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.DESIGN: Comparative prospective cohort study.SETTING: 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.PARTICIPANTS: 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).INTERVENTIONS: 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.MAIN OUTCOME MEASURES: 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 KOOS4 scores 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 KOOS4 score 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.
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| 5. |
- Tornbjerg, Simon Maretti, et al.
(author)
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Structural pathology is not related to patientreported pain and function in patients undergoing meniscal surgery
- 2017
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In: British journal of sports medicine. - : BMJ. - 0306-3674 .- 1473-0480. ; 51, s. 525-530
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Journal article (peer-reviewed)abstract
- Background The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal surgery. Methods This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification of meniscal tears questionnaire, supplemented with information extracted from surgery reports. Following hypothesis-driven preselection of candidate variables, backward elimination regressions were performed to investigate associations between patient-reported outcomes and structural knee pathologies. Results Regression models only explained a small proportion of the variability in self-reported pain and function (adjusted R2=0.10-0.12) and this association was mainly driven by age, gender and body mass index. Conclusions Specific meniscal pathology and other structural joint pathologies found at meniscal surgery were not associated with preoperative self-reported pain and function in patients with meniscal tears questioning inferences made about a direct relationship between these. Our findings question the role of arthroscopic surgery to address structural pathology as a means to improve patient-reported outcomes in patients having surgery for a meniscal tear.
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