Maximum subjective outcome improvement is reported by 3 Months following arthroscopic partial meniscectomy: A systematic review

Abstract

Purpose: To review patient outcomes in the literature following arthroscopic partial meniscectomy (APM) in order to identify when patients report reaching subjective maximal improvement postoperatively.

Methods: A systematic review of the literature from January 2004 to August 2019 was conducted using PRISMA guidelines to identify articles evaluating patient-reported outcome measures (PROMs) up to a minimum of 6 months after APM in patients >18 years old. Studies were excluded if additional interventions were performed such as repairs, ligamentous reconstruction or repair, cartilaginous manipulation, or revision surgery. PROMs were pooled between studies at preoperative, 3 months, 6 months, 1 year, and 2 year time points. Weighted averages were used within a mixed model method in order to account for the differences in sample size and variance among studies. Significant improvements in PROMs at various time intervals were statistically analyzed using minimal clinically important difference.

Results: A total of 12 studies including 1663 patients who underwent APM were selected for the review. The pooled cohort consisted of 1033 (62%) males and 630 (38%) females. Significant improvements were demonstrated from preoperative scores to 3 months postoperatively in Knee Injury and Osteoarthritis Outcome Score subcategories, Lysholm, and visual analog scale scores while no differences were found for Tegner and International Knee Documentation Committee scores. Although statistically significant improvement in PROMs remained at all postoperative time points compared to preoperative scores, no significant differences were observed after 3 months postoperatively.

Conclusions: Patients undergoing APM had significant mean changes in legacy PROMs by 3 months postoperatively that exceeded given minimal clinically important difference values, without further clinically important improvement reported up to 2 years postoperatively.

Study design: Level III, systematic review.

Keywords: Arthroscopic; Knee; Maximal medical improvement; Meniscal tear; Meniscectomy; Meniscus; Patient-reported outcome measures.

Fig. 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of inclusion process. A total of 209 articles were excluded if additional interventions were performed such as repairs, ligamentous reconstruction or repair, cartilaginous manipulation, revisions, if the patient was under 18 years of age, research conducted prior to 2000, follow-up and outcome reporting were less than 6 months postoperatively, or level of evidence was below level III, and articles that were meta-analyses or systematic reviews. Articles were excluded if data were not reported or if data were incomplete for outcome scores.