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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

基本信息

批准号：
10227110
负责人：
NAVEEN SUBHAS
金额：
$ 20.61万
依托单位：
CLEVELAND CLINIC LERNER COM-CWRU
依托单位国家：
美国
项目类别：
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/10227110
关键词：
Age Age-Years Arthroscopy Body mass index 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 meniscal tear older patient outcome prediction pain score patient population point of care predictive modeling responders and non-responders tool

项目摘要

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.

抽象的关节镜部分半月板切除术 (APM) 是最常进行的门诊骨科手术在美国，几乎一半的此类手术是在 45 岁以上的患者中进行的，通常伴有骨关节炎。先前的临床试验发现 APM 与非手术治疗相比没有显着益处对患有半月板撕裂和骨关节炎 (OA) 的老年患者进行治疗，并建议这些患者在追求 APM 之前应该首先接受一个物理治疗过程。即使在 APM 之后执行然而，物理治疗过程失败后，近 20% 的患者没有获得具有临床意义的康复效果。改进。目前，还没有可用的术前工具可以预测手术的可能性。在 APM 治疗后，该患者群体取得了成功的结果。术前磁共振成像（MRI）结果已被证明与小型研究的结果相关，这些研究在具有重大局限性的性质。常规临床实践中使用的术前 MRI 预测的价值 APM 后的结果仍不清楚。我们相信术前 MRI 结果，包括病情的严重程度软骨损失可以帮助区分对手术有反应的人和无反应的人。我们机构规模大超过 1000 名患者的前瞻性队列，具有基线和 1 年患者报告的结果测量（PROM）和术前 MRI，提供了一个独特的数据集来进行足够的研究确定接受 APM 的患者 PROM 预测因素的样本量。本研究的目的是确定 45 岁及以上无临床症状的患者的术前 MRI 预测因子 APM 后 PROM 得到显着改善。具体来说，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 结果所有潜在的混杂因素。我们还将开发预测工具，利用这些 MRI 风险因素来识别那些会或不会从可用于帮助指导临床决策的 APM 中受益的患者。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。