Surgical Trends in the Treatment of Meniscal Tears: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database
Surgical Trends in the Treatment of Meniscal Tears: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database
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DOI：
10.1177/0363546516638082
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发表时间：
2016-07-01
影响因子：
4.8
通讯作者：
Kamath, Ganesh
中科院分区：
文献类型：
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作者：
Parker, Benjamin R.;Hurwitz, Shepard;Kamath, Ganesh
背景：随着对生物力学、关节病理生理学的新认识和医师教育的增加，半月板修复的适应症和标准正在扩大。目的：描述近年来关节镜下半月板治疗的实践模式，比较关节镜下半月板修复和关节镜下半月板切除术的趋势，比较2004年至2012年美国矫形外科委员会(ABOS)考生在关节镜下半月板治疗技术方面的差异。研究设计：描述性流行病学研究。方法：使用ABOS数据库识别2004-2012年间半月板修复、半月板部分切除和前交叉韧带重建的病例。每个日历年的外科医生贡献病例的数量也被记录下来，以及接受过体育奖学金培训的数量。费率是根据每位外科医生每年的手术次数计算的。结果：每个外科医生的半月板手术率从2004年的18.4例下降到2012年的16.2例，下降了12%。接受过体育奖学金培训的外科医生(7%)的降幅小于未接受体育奖学金培训的外科医生(32%)。每名外科医生半月板修复率由1.6例增加到2.2例，增幅为37%。半月板切除率从16.8例下降到14.0例，下降了17%。当比较接受团契训练的外科医生和未接受团契训练的外科医生时，随着时间的推移，半月板修复率没有显著差异。未接受过团契培训的外科医生的半月板切除率下降了35%，而接受过团契培训的外科医生仅为11%。结论：这项研究为近期骨科培训毕业生治疗半月板撕裂的实践趋势提供了洞察力。结果表明，报道的半月板手术在ABOS患者中总体上减少了，但半月板修复病例增加了。这些发现支持了最近向循证医学的转变，实践模式的变化可能反映了该领域大型高质量研究的最新发现的传播。
Background: The indications and criteria for meniscal repair are expanding in parallel with new understanding in biomechanics, joint pathophysiology, and increased physician education.Purpose: To describe the practice patterns of arthroscopic meniscal treatment in recent years, compare the trends of arthroscopic meniscal repair versus arthroscopic meniscectomy, and compare sports fellowship-trained versus non-sports fellowship-trained surgeons in terms of arthroscopic meniscal treatment techniques among American Board of Orthopaedic Surgery (ABOS) candidates from 2004 to 2012.Study Design: Descriptive epidemiology study.Methods: The ABOS database was used to identify cases of meniscal repair, partial meniscectomy, and anterior cruciate ligament (ACL) reconstruction from 2004 to 2012. The number of surgeons contributing cases for each calendar year was also recorded, along with the number who had sports fellowship training. Rates were calculated as the number of procedures per surgeon per year. Trends were analyzed using Poisson regression analysis to model the rate of each procedure over time.Results: The rate of all meniscal procedures per surgeon decreased 12% from 18.4 cases per surgeon in 2004 to 16.2 cases per surgeon in 2012. There was a smaller decrease for sports fellowship-trained surgeons (7%) than for non-sports fellowship-trained surgeons (32%). The rate of meniscal repair cases per surgeon increased 37% from 1.6 to 2.2 cases per surgeon. The rate of meniscectomy cases decreased 17% from 16.8 to 14.0 cases per surgeon. When comparing fellowship-trained surgeons to non-fellowship-trained surgeons, there was no significant difference in meniscal repair rates over time. There was a decrease of 35% in rates of meniscectomy among non-fellowship-trained surgeons compared with 11% among fellowship-trained surgeons.Conclusion: This study provides insight into the current practice trends of recent orthopaedic training graduates in the treatment of meniscal tears. The results suggest that reported meniscal procedures have decreased overall among ABOS candidates but that meniscal repair cases have increased. The findings support the recent shift toward evidence-based medicine, with changing practice patterns that may reflect the dissemination of recent findings from large, high-quality research studies in this field.