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Meta-Analysis
. 2025 Aug 27;9(9):e24.00315.
doi: 10.5435/JAAOSGlobal-D-24-00315. eCollection 2025 Sep 1.

Reporting the Pooled Last Follow-up Musculoskeletal Tumor Society Score Underestimates Functional Improvements Seen Over Time

Alysia K Kemp  1 , Theresa Nalty, Grant McChesney, Yimin Geng, Shalin S Patel, Valerae O Lewis, Justin E Bird
Affiliations
Meta-Analysis

Reporting the Pooled Last Follow-up Musculoskeletal Tumor Society Score Underestimates Functional Improvements Seen Over Time

Alysia K Kemp et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Introduction: The Musculoskeletal Tumor Society (MSTS) score is the most commonly used functional outcome tool in Orthopaedic Oncology. However, there are no published recommendations on how to collect, analyze, and report these data. To address this knowledge gap, we performed (1) a systematic review to analyze the methodology of reporting MSTS scores and (2) an analysis of two different reporting methods (pooled last follow-up versus longitudinal time based).

Methods: The mean MSTS score and length of follow-up were calculated using data provided in articles included in the systematic review. Paired t-tests were used to compare mean MSTS scores calculated at standardized postoperative intervals versus mean MSTS scores calculated from last follow-up time points using prospectively collected data from a single institutional database.

Results: More than 300 articles met inclusion criteria. Most authors reported a single pooled score calculated from MSTS scores obtained at the patients' last follow-up visits (91.6%, n = 356). When comparing this method (pooled reporting) versus longitudinal time-based reporting, the pooled MSTS scores were only comparable to the MSTS scores at the 6-month postoperative visit. The pooled last follow-up scores underestimated MSTS scores obtained after 6 months (P < 0.0001 at 1 year and P = 0.0047 at 3 years). Improvements were seen in the MSTS domains after the 6-month visit (average time to stability was 1.8 years).

Conclusion: The most common historical method of reporting MSTS scores, the pooled last follow-up method, underestimates functional improvements observed during long-term follow-up. Longitudinal time-based reporting provides more accurate representation of the functional outcomes over time.

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Conflict of interest statement

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Kemp, Dr. Nalty, Dr. McChesney, Dr. Geng, Dr. Patel, Dr. Lewis, and Dr. Bird.

Figures

Figure 1
Figure 1
Flow chart showing the Preferred Reporting Items for Systemic Review and Meta-Analysis details of the number of articles identified, included, and excluded.
Figure 2
Figure 2
Graphical representation showing how MSTS93 scores were collected at standardized postoperative intervals. MSTS = Musculoskeletal Tumor Society
Figure 3
Figure 3
Graphical representation showing the pooled MSTS93 score calculated from values obtained at the patient's last follow-up visit. MSTS = Musculoskeletal Tumor Society
Figure 4
Figure 4
Graph showing the primary diagnoses for patients treated for impending or pathologic long bone fractures.
Figure 5
Figure 5
Graph showing the mean MSTS 93 lower extremity score at standardized preoperative (1) and postoperative intervals at 2 weeks (2), 6 weeks (3), 3 months (4), 6 months (5), 1 year (6), 2 years (7), 3 years (8), 4 years (9), 5 years (10), 6 years (11), 7 years (12), and pooled last follow-up (14). MSTS = Musculoskeletal Tumor Society
See this image and copyright information in PMC

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