Defining clinically relevant outcome thresholds for pain and function after osteochondral autograft transplantation of the knee

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-08-10 DOI:10.1002/ksa.12422

Kyle N. Kunze, Nathan H. Varady, Arjun Khorana, Scott A. Rodeo, Russell F. Warren, Thomas L. Wickiewicz, Riley J. Williams III

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引用次数: 0

Abstract

Purpose

To define the minimal clinically important difference (MCID) for measures of pain and function at 2, 5 and 10 years after osteochondral autograft transplantations (OATs).

Methods

Patients undergoing OATs of the knee were identified from a prospectively maintained cartilage surgery registry. Baseline demographic, injury and surgical factors were collected. Patient-reported outcome scores (PROMs) were collected at baseline, 2-, 5- and 10-year follow-up, including the International Knee Documentation Committee (IKDC) score, Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), Marx activity scale and Visual Analogue Scale (VAS) for pain. The MCIDs were quantified for each metric utilizing a distribution-based method equivalent to one-half the standard deviation of the mean change in outcome score. The percentage of patients achieving MCID as a function of time was assessed.

Results

Of 63 consecutive patients who underwent OATs, 47 (74.6%) patients were eligible for follow-up (surgical date before October 2021) and had fully completed preoperative PROMs. A total of 39 patients (83%) were available for a minimum 2-year follow-up, with a mean (±standard deviation) follow-up of 5.8 ± 3.4 years. The MCIDs were determined to be 9.3 for IKDC, 2.5 for Marx, 7.4 for KOS-ADLS and 12.9 for pain. At 2 years, 78.1% of patients achieved MCID for IKDC, 77.8% for Marx, 75% for KOS-ADLS and 57.9% for pain. These results were generally maintained through 10-year follow-ups, with 75% of patients achieving MCID for IKDC, 80% for Marx, 80% for KOS-ADLS and 69.8% for pain.

Conclusions

The majority of patients achieved a clinically relevant outcome improvement after OATs of the knee, with results sustained through 10-year follow-up. Patients who experience clinically relevant outcome improvement after OATs in the short term continue to experience sustained benefits at longer-term follow-up. These data provide valuable prognostic information when discussing patient candidacy and the expected trajectory of recovery.

Level of Evidence

Level III.

查看原文本刊更多论文

确定膝关节骨软骨自体移植术后疼痛和功能的临床相关结果阈值。

目的：确定骨软骨自体移植（OAT）后2年、5年和10年疼痛和功能测量的最小临床重要差异（MCID）：方法：接受膝关节自体软骨移植手术的患者均来自前瞻性软骨手术登记处。收集了基线人口统计学、损伤和手术因素。在基线、2年、5年和10年随访时收集患者报告的结果评分（PROMs），包括国际膝关节文献委员会（IKDC）评分、膝关节结果调查日常生活活动量表（KOS-ADLS）、马克思活动量表和疼痛视觉模拟量表（VAS）。每项指标的 MCID 均采用基于分布的方法进行量化，相当于结果评分平均变化的二分之一标准差。评估了达到 MCID 的患者比例与时间的函数关系：在 63 名连续接受 OAT 的患者中，有 47 名（74.6%）患者符合随访条件（手术日期在 2021 年 10 月之前），并完整填写了术前 PROM。共有 39 名患者（83%）接受了至少 2 年的随访，平均（± 标准差）随访时间为 5.8±3.4 年。经测定，IKDC的MCID为9.3，Marx为2.5，KOS-ADLS为7.4，疼痛为12.9。2 年后，78.1% 的患者达到了 IKDC 的 MCID，77.8% 的患者达到了 Marx 的 MCID，75% 的患者达到了 KOS-ADLS 的 MCID，57.9% 的患者达到了疼痛的 MCID。这些结果在10年的随访中基本保持不变，75%的患者达到了IKDC的MCID，80%的患者达到了Marx的MCID，80%的患者达到了KOS-ADLS的MCID，69.8%的患者达到了疼痛的MCID：结论：大多数患者在接受膝关节OAT治疗后都获得了临床相关的疗效改善，并能在10年的随访中保持疗效。在短期内接受膝关节OAT治疗后临床效果得到改善的患者，在长期随访中仍能持续获益。这些数据为讨论患者的候选资格和预期恢复轨迹提供了宝贵的预后信息：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).