MRI Predictors of Outcome after Arthroscopic Partial Meniscectomy

摘要 关节镜下部分椎间盘切除术（APM）是最常见的门诊骨科手术 在美国，几乎一半的手术是在45岁以上的患者中进行的， 伴有骨关节炎。先前的临床试验没有发现APM比非手术治疗有显著的益处。 治疗老年患者的关节撕裂和骨关节炎（OA），并已建议这些患者 应先接受一个疗程的物理治疗，然后才进行APM。即使当APM在一个 然而，在物理治疗失败的患者中，几乎20%的患者没有临床意义的 改进.目前，没有可用的术前工具可以预测 在这一患者群体中，APM治疗后取得了成功的结果。术前磁共振成像 (MRI)研究结果已被证明与小型研究的结果相关，这些研究在以下方面进行了探索： 大自然有很大的局限性。术前MRI在常规临床实践中用于预测 APM后的结果仍不清楚。我们认为，术前MRI结果，包括严重程度， 软骨损失，可以帮助区分反应者和非反应者。我们的机构很大 超过1000例患者的前瞻性队列，包括基线和1年患者报告的结局 测量（PROM）和术前MRI，提供了一个独特的数据集，以进行研究， 样本量，以确定接受APM的患者中PROM的预测因素。本研究的目的是 确定45岁及以上患者的术前MRI预测因素，这些患者将没有临床症状， 在APM之后的PROM中有意义的改进。通过构建多变量模型，我们 将确定与疼痛和功能改善相关的术前MRI结果， 所有潜在的混杂因素。我们还将开发预测工具，使用这些MRI风险因素，以确定 将从APM中受益和不受益的患者，可用于帮助指导临床决策。 我们相信使用这些工具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进行测试。

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.