Original Article
Predictors of Short-term Recovery Differ From Those of Long-term Outcome After Arthroscopic Partial Meniscectomy

https://doi.org/10.1016/j.arthro.2008.02.015Get rights and content

Purpose: The purpose of this study was to determine which patient clinical and demographic factors are associated with the short-term rate of recovery from arthroscopic partial meniscectomy in the year after surgery and how they differ from previously published associations with long-term outcome. Methods: Depth of meniscal excision, involvement of 1 or both menisci, extent of meniscal tear, and extent of osteoarthritis were determined during surgery, and age, body mass index, and gender were recorded. Mixed-model repeated-measures analyses were used longitudinally to identify independent predictors of recovery, measured by prospectively assessing knee pain, knee function, and overall physical knee status preoperatively and at regular intervals throughout postoperative recovery. Results: Neither advanced age nor increased body mass index had any influence on patient recovery over time, whereas gender was implicated, with women having significantly poorer recovery scores than men (P < .04). In addition, differences in variables indicating extent of meniscal tear and resection did not influence recovery scores over time, and the only surgical factor that impacted all 3 recovery variables was extent of osteoarthritis (P < .02). Conclusions: We have shown that female gender and worse osteoarthritis are associated with a slower rate of short-term recovery from arthroscopic partial meniscectomy whereas age, obesity, and amount of meniscal tear/resection showed no association with rate of recovery throughout the first year postoperatively. Level of Evidence: Level I, high-quality prognostic prospective study (all patients were enrolled at the same point in their disease with more than 80% follow-up of enrolled patients).

Section snippets

Methods

One hundred twenty-six consecutive arthroscopic partial meniscectomy procedures were performed and prospective data were collected between August 2000 and August 2005 by 1 surgeon at a major university medical center. Demographic characteristics of the patient sample are shown in Table 1. All patients were given a preoperative diagnosis of torn medial meniscus, torn lateral meniscus, or both based on history, physical examination, and confirmatory magnetic resonance imaging. In addition,

Results

Tear characteristics, including incidence of 1 meniscus versus both menisci, number of zones involved, and depth of meniscal excision are shown in Table 2. The distribution of modified Outerbridge scores is shown in Table 3; intercorrelations between the 4 surgical predictor variables are shown in Table 4.

Results of the mixed-model repeated-measures analyses are shown in Table 5. Of the demographic variables, gender was significantly associated with rate of improvement in knee pain, knee

Discussion

Currently, physicians are forced to advise patients regarding their short-term recovery based on anecdotal evidence from their own experience, including intuitions about how patients will recover based on age, weight, incentive to recover, amount of tissue resected, and amount of physical therapy that they receive, rather than being able to refer to published data. Although 1 previous study reported general information concerning when patients could return to work, school, or daily activity to

Conclusions

We have shown that female gender and worse osteoarthritis are associated with a slower rate of recovery from arthroscopic partial meniscectomy whereas age, BMI, depth of meniscal excision, involvement of 1 or both menisci, and extent of meniscal tear showed no association throughout the first year postoperatively.

Acknowledgment

The authors thank Dr. Michael Medvecky for contributing the examples of intraoperative arthroscopic images (Fig 2) for this article.

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    Supported by funding from the National Institute of Arthritis and Musculoskeletal and Skin Disorders (No. R01 AR46299). Additional funding was contributed by the Felix Freshwater Student Research Fellowship. Research was performed at Yale University School of Medicine. The authors report no conflict of interest.

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