Establishing Clinically Significant Outcomes After Meniscal Allograft Transplantation.

Background: Traditionally, the primary outcome in meniscal allograft transplantation (MAT) has been long-term survivorship; however, short-term clinically significant outcomes are necessary to fully evaluate patient improvement after surgery.
Purpose: To (1) establish the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) with respect to patient-reported outcome measures (PROMs) and (2) evaluate preoperative and intraoperative variables correlated with achieving these threshold values.
Study Design: Cohort study (diagnosis); Level of evidence, 2.
Methods: A prospectively maintained institutional registry was queried for all MATs performed between 1999 and 2017. The following PROM scores were collected: International Knee Documentation Committee (IKDC) score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Patients who completed preoperative and postoperative PROMs within a 1-month window were included to calculate the distribution-based MCID at this interval. An anchor question regarding satisfaction with surgery was asked at the same time point and was employed to determine the PASS using nonparametric receiver operating characteristic curve/area under the curve analysis. Multivariate regression analysis was performed to correlate patient demographics, medical history, and concomitant procedures to propensity in achieving the MCID and PASS.
Results: A total of 98 patients who underwent MAT met the inclusion/exclusion criteria, of whom 10 underwent concomitant ligamentous procedures, 65 underwent concomitant cartilage procedures, and 7 underwent concomitant realignment procedures. The mean patient age was 29.4 ± 9.0 years, and the mean body mass index (BMI) was 26.8 ± 5.2 kg/m ² . The distribution-based MCID and PASS were determined for the Lysholm score (12.3 and 66.5) and IKDC (9.9 and 36.0) as well as the KOOS Pain (9.9 and N/A ), Symptoms (9.7 and 73.0), Activities of Daily Living (9.5 and N/A), Sport (13.3 and N/A), and Quality of Life (14.6 and 53.0) subscales, respectively. A preoperative Short Form Physical Component Summary (SF PCS) score greater than 32.0 was predictive of postoperative satisfaction. Patients with work-related claims had a reduced likelihood of achieving the MCID for the IKDC and the PASS for the KOOS Symptoms. An increased BMI was also associated with failing to achieve the PASS for the KOOS Quality of Life (QOL).
Conclusion: This study established the MCID and PASS for the Lysholm score, IKDC, and KOOS in patients undergoing MAT. Workers' compensation and higher BMI were associated with failing to achieve clinically significant values. Lower preoperative Lysholm, IKDC, and KOOS scores were predictive of achieving the MCID, while higher preoperative SF PCS scores were associated with achieving satisfaction after MAT.
Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.B.Y. has received hospitality payments from Stryker, Organogenesis, Arthrex, Ceterix Orthopaedics, Aastrom Biosciences, and Smith & Nephew; receives research support from Arthrex and MedWest; is a consultant for Aastrom Biosciences; and has received educational support from Arthrex and Smith & Nephew. B.J.C. is a consultant for Arthrex, Geistlich Pharma, Smith & Nephew, Bioventus, Vericel, Zimmer Biomet, Anika Therapeutics, Pacira Pharmaceuticals, and Isto Technologies; receives royalties from Arthrex, DJO, and Encore Medical; is a paid speaker/presenter for Arthrex, LifeNet Health, Carticept Medical, and Pacira Pharmaceuticals; has received educational support from Arthrex and Pacira Pharmaceuticals; and has received hospitality payments from Arthrex, Geistlich Pharma, LifeNet Health, GE Healthcare, Vericel, Aesculap Biologics, DePuy Synthes, Genzyme, and Pacira Pharmaceuticals. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.