对 Kellgren-Lawrence 3 级骨关节炎患者进行关节镜下半月板部分切除术，可显著改善临床疗效

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-06-01 DOI:10.1016/j.asmr.2024.100926

Tyler Warner B.S. , Natalie Lowenstein M.P.H. , Jillian Mazzocca B.A. , Jamie Collins Ph.D. , Elizabeth Matzkin M.D.

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引用次数: 0

摘要

目的评估术前膝关节X光片显示凯尔格伦-劳伦斯（Kellgren-Lawrence，KL）3级且有症状的半月板撕裂患者行关节镜下半月板部分切除术（APM）后的患者报告结果指标（PROMs）。如果患者术前膝关节X光片显示有KL 3级骨关节炎，并在APM前完成了至少6周的非手术治疗试验，则将其纳入研究范围。如果患者患有炎症性关节炎、术前和/或术后1年随访数据不完整、重复进行膝关节镜检查以及合并韧带损伤，则排除在外。统计分析使用术前和术后2年的PROMs来评估改善情况，使用的量表是之前确定的阈值，包括最小临床重要性差异（MCID）和实质性临床获益（SCB）。结果82名患者符合资格标准（49名女性[60%]，平均[标码]年龄为53.1[9.3]岁）。随访 1 年时，大多数患者都达到了 MCID：膝关节损伤和骨关节炎结果评分 (KOOS) 疼痛 73%、KOOS 症状 66% 和 KOOS 日常生活活动 (ADL) 78%。这些改善在 2 年的随访中表现相似：各分量表的改善率分别为 75%、72% 和 79%。术后 1 年的 SCB 也得到了证实，在 KOOS 疼痛、症状和 ADL 分量表中，分别有 56%、73% 和 71% 达到了 SCB。这些结果在两年的随访中基本保持不变。术后 1 年和 2 年的疼痛视觉模拟量表评分也有所改善，与基线相比，平均改善幅度分别为 2.80 分和 2.87 分。结论在至少1年的随访中，大多数KL 3级和半月板撕裂的患者在KOOS疼痛、KOOS症状和KOOS ADL方面都达到了MCID和SCB，这表明这些患者的治疗效果得到了显著改善。

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Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes

Purpose

To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear.

Methods

This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB).

Results

Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up.

Conclusions

At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients.