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Randomized Controlled Trial
. 2022 Jan;30(1):231-238.
doi: 10.1007/s00167-021-06468-0. Epub 2021 Feb 7.

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

Julia C A Noorduyn  1 , M M H Teuwen  2   3 , V A van de Graaf  2   4 , N W Willigenburg  2 , M Schavemaker  5 , R van Dijk  6 , G G M Scholten-Peeters  7 , M W Heymans  8 , M W Coppieters  7   9 , R W Poolman  2   3 ; ESCAPE Research Group
Collaborators, Affiliations
Randomized Controlled Trial

In patients eligible for meniscal surgery who first receive physical therapy, multivariable prognostic models cannot predict who will eventually undergo surgery

Julia C A Noorduyn et al. Knee Surg Sports Traumatol Arthrosc. 2022 Jan.

Abstract

Purpose: Although physical therapy is the recommended treatment in patients over 45 years old with a degenerative meniscal tear, 24% still opt for meniscal surgery. The aim was to identify those patients with a degenerative meniscal tear who will undergo surgery following physical therapy.

Methods: The data for this study were generated in the physical therapy arm of the ESCAPE trial, a randomized clinical trial investigating the effectiveness of surgery versus physical therapy in patients of 45-70 years old, with a degenerative meniscal tear. At 6 and 24 months patients were divided into two groups: those who did not undergo surgery, and those who did undergo surgery. Two multivariable prognostic models were developed using candidate predictors that were selected from the list of the patients' baseline variables. A multivariable logistic regression analysis was performed with backward Wald selection and a cut-off of p < 0.157. For both models the performance was assessed and corrected for the models' optimism through an internal validation using bootstrapping technique with 500 repetitions.

Results: At 6 months, 32/153 patients (20.9%) underwent meniscal surgery following physical therapy. Based on the multivariable regression analysis, patients were more likely to opt for meniscal surgery within 6 months when they had worse knee function, lower education level and a better general physical health status at baseline. At 24 months, 43/153 patients (28.1%) underwent meniscal surgery following physical therapy. Patients were more likely to opt for meniscal surgery within 24 months when they had worse knee function and a lower level of education at baseline at baseline. Both models had a low explained variance (16 and 11%, respectively) and an insufficient predictive accuracy.

Conclusion: Not all patients with degenerative meniscal tears experience beneficial results following physical therapy. The non-responders to physical therapy could not accurately be predicted by our prognostic models.

Level of evidence: III.

Keywords: Knee; Meniscus; Physical therapy; Prognostic model.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declared.

References

    1. Abram SGF, Hopewell S, Monk AP, Bayliss LE, Beard DJ, Price AJ. Arthroscopic partial meniscectomy for meniscal tears of the knee: a systematic review and meta-analysis. Br J Sports Med. 2019 doi: 10.1136/bjsports-2018-100223. - DOI - PubMed
    1. Berg B, Roos EM, Englund M, Kise NJ, Tiulpin A, Saarakkala S, et al. Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthr Cartil. 2020;28:897–906. doi: 10.1016/j.joca.2020.01.020. - DOI - PubMed
    1. Field A. Discovering statistics using IBM SPSS Statistics. 4. London: SAGE Publications; 2013.
    1. Gauffin H, Tagesson S, Meunier A, Magnusson H, Kvist J. Knee arthroscopic surgery is beneficial to middle-aged patients with meniscal symptoms: a prospective, randomised, single-blinded study. Osteoarthr Cartil. 2014;22:1808–1816. doi: 10.1016/j.joca.2014.07.017. - DOI - PubMed
    1. Herrlin SV, Wange PO, Lapidus G, Hallander M, Werner S, Weidenhielm L. Is arthroscopic surgery beneficial in treating non-traumatic, degenerative medial meniscal tears? A five year follow-up. Knee Surg Sports Traumatol Arthrosc. 2013;21:358–364. doi: 10.1007/s00167-012-1960-3. - DOI - PubMed

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