MRI Predictors of Outcome after Arthroscopic Partial Meniscectomy

关节镜部分半月板切除术后结果的 MRI 预测因素

• 批准号: 9973206
• 负责人: NAVEEN SUBHAS
• 金额: $ 21.25万
• 依托单位: CLEVELAND CLINIC LERNER COM-CWRU
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9973206
• 关键词: Age; Age-Years; Arthroscopy; Bone Marrow; Cartilage; Characteristics; Clinical; Clinical Trials; Coupled; Data Set; Degenerative polyarthritis; Diagnostic radiologic examination; Edema; Future; Gender; Healthcare Systems; Institution; Knee; Knee Injuries; Knee Osteoarthritis; Lateral meniscus structure; Lesion; Magnetic Resonance Imaging; Measurement; Meniscus structure of joint; Meteor; Modeling; Nature; Operative Surgical Procedures; Orthopedic Procedures; Outcome; Outcome Measure; Pain; Patient Outcomes Assessments; Patients; Physical therapy; Plant Roots; Predictive Factor; Procedures; Prognostic Factor; Prospective cohort; Psyche structure; Randomized; Reporting; Research Personnel; Risk Factors; Sample Size; Severities; Site; Socioeconomic Status; Surgeon; System; Testing; Thick; Treatment Failure; United States; Unnecessary Surgery; Variant; clinical decision-making; clinical practice; clinically significant; comorbidity; control trial; cost; older patient; outcome prediction; pain score; patient population; point of care; predictive modeling; responders and non-responders; tool

ABSTRACT Arthroscopic partial meniscectomy (APM) is the most commonly performed ambulatory orthopaedic procedure in the United States, with almost half of these procedures performed in patients over 45 years of age, often with concomitant osteoarthritis. Prior clinical trials have found no significant benefit of APM over non-surgical treatment in older patients with meniscal tears and osteoarthritis (OA) and have been suggested these patients should first undergo a course of physical therapy before pursuing APM. Even when APM is performed after a failed course of physical therapy, however, almost 20% of these patients do not have a clinically meaningful improvement. At present, there is no preoperative tool that is available which can predict the likelihood of having a successful outcome after APM in this patient population. Preoperative magnetic resonance imaging (MRI) findings have been shown to correlate with outcomes in small studies which have been exploratory in nature with significant limitations. The value of preoperative MRI, as used in routine clinical practice, to predict outcome after APM remains unclear. We believe that preoperative MRI findings, including the severity of cartilage loss, can help differentiate responders from non-responders to surgery. Our institution's large prospective cohort of greater than 1000 patients, with baseline and 1-year patient reported outcomes measures (PROMs) and preoperative MRIs, provides a unique data set to perform a study with sufficient sample size to identify the predictors of PROMs in patients undergoing APM. The objective of this study is to identify the preoperative MRI predictors in patients 45 years old and older who will have no clinically meaningful improvement in PROMs after APM. Specifically by constructing multiple variable models, we will identify preoperative MRI findings that are associated with improvement in pain and function adjusting for all potential confounders. We will also develop prediction tools, using these MRI risk factors, to identify patients who will and will not benefit from APM that can be used to help guide clinical decision making. We believe that the use of these tools will reduce unnecessary surgeries and cost to the healthcare system which we plan to test in a future randomized control trial.

摘要 关节镜下半月板部分切除术(Apm)是最常用的非卧床矫形手术。 在美国，这些手术中有近一半是在45岁以上的患者身上进行的，通常 伴随着骨性关节炎。先前的临床试验发现，与非手术相比，APM没有明显的好处。 治疗患有半月板撕裂和骨关节炎(OA)的老年患者，并建议这些患者 在追求APM之前，应该首先接受一个疗程的物理治疗。即使在执行APM之前 然而，理疗失败的患者中，几乎有20%的患者没有临床意义 进步。目前，还没有可用的术前工具来预测 在这些患者群体中，APM后有成功的结果。术前磁共振成像 (MRI)的发现已被证明与小规模研究的结果相关，这些研究已经在 自然界有很大的局限性。术前MRI在临床常规检查中的应用价值 APM后的结果仍不清楚。我们认为，术前核磁共振表现，包括严重程度 软骨丢失，有助于区分对手术有反应的人和无反应的人。我们的机构很大 超过1000名患者的预期队列，以及基线和1年患者报告的结果 测量(PROM)和术前核磁共振成像，提供了一个独特的数据集，以执行足够的研究 样本量以确定APM患者胎膜早破的预测因素。这项研究的目的是 确定45岁及以上无临床症状患者的术前MRI预测因素 APM后胎膜早破的有意义的改善。具体地说，通过构建多变量模型，我们 将确定与疼痛改善和功能调整相关的术前MRI表现 都是潜在的混血儿。我们还将开发预测工具，使用这些MRI风险因素来确定 将受益于和不将受益于可用于指导临床决策的APM的患者。 我们相信，这些工具的使用将减少不必要的手术和医疗保健系统的成本 我们计划在未来的随机对照试验中对其进行测试。