Poster 275: Predictors of Surgical Outcome in Patients Undergoing Meniscectomy
Authors: Kurkowski Sarah , Kuechly Henry , Bonamer John , Johnson Brian , Grawe Brian 
Published: August 2024

Objectives:

The benefits and outcomes of meniscectomy surgery is a controversial topic among orthopedic surgeons. Though previous studies have sought to address the controversy, there are few that have identified predictors of postoperative outcomes from patient demographics or injury characteristics. Meniscectomy may be beneficial in certain populations of patients and not beneficial (or non-superior to nonoperative treatment) in other populations. This study aimed to identify predictors/risk factors of postoperative outcomes in patients undergoing meniscectomy.

Methods:

This single-center prospective study consisted of 90 patients who underwent meniscectomy surgery for knee pain/pathology from 2021-2022. General demographic information and patient-reported outcomes were prospectively collected using SF-12, SF-36, and IKDC surveys prior to surgery and at 6-month follow-up. Preoperative clinical and surgical information was collected via electronic medical records. Psychiatric history was reported if a patient had a formal DSM-V diagnosis and/or was prescribed psychiatric medication. Post-surgery outcomes were patient-reported satisfaction (answered “yes” or “no”) and obtaining a pass on postoperative IKDC score. Data were analyzed with odds ratios and binomial logistic regression.

Results:

There was a total of 90 patients prospectively enrolled in the study who underwent meniscectomy surgery. Patients had an average age of 52.54 ± 13.06 years and BMI of 30.42 ± 6.16 kg/m2. 44.56% of patients were male. Odds ratios (OR) of patient demographics (use of Medicaid insurance, diabetes, BMI, psychiatric history, chronic pain, and preoperative SF-36 scores) were calculated. Patient demographics that were deemed as significant predictors of obtaining a pass on postoperative IKDC score were Medicaid insurance (OR=0.056; 95% CI 0.003, 1.001), psychiatric history (OR=0.091; 95% CI 0.025, 0.335), chronic pain (OR=0.106; 95% CI 0.013, 0.873), and preoperative SF-36 physical health (OR=1.098; 95% CI 1.039, 1.160) and mental health scores (OR=1.071; 95% CI 1.014, 1.130). Preoperative SF-36 physical health score was the only significant predictor of patient-reported satisfaction post-surgery (OR=1.069; 95% CI 1.016, 1.125) (Table 1). Odds ratios of injury characteristics (injury acuity, ligamentous involvement, patellar arthritis, medial compartment arthritis, lateral compartment arthritis, and trochlear arthritis) were calculated. Characteristics that were found to be significant predictors of obtaining a pass on postoperative IKDC score were acuity of injury (OR=0.387; 95% CI 0.164, 0.914) and patellar arthritis (OR=0.325; 95% CI 0.122, 0.868). Lateral compartment arthritis was nearing significance (OR=0.432; 95% CI 0.185, 1.012). No injury characteristics were found to be significant predictors of patient-reported satisfaction. Specific Kellgren-Lawrence grades of arthritis were not significant predictors of outcome (Table 2).

Conclusions:

The data identify pertinent patient demographics and injury characteristics that are predictors for post-meniscectomy outcomes such as patient-reported satisfaction and obtaining a pass on IKDC score. Particularly interesting is the impact of psychiatric history on the patient obtaining a pass on postoperative IKDC score. Patients with psychiatric history had lower odds of obtaining a pass score than those without it. This emphasizes the importance of both empathy and expectations by the orthopedic surgeon when considering meniscectomy in this patient population. Though a patient should not be denied necessary surgery, it may be important to address the psychiatric disease prior to or concomitantly with operative treatment. Pre-operative PHS and MHS values from the SF-36 survey were both predictive of obtaining pass on post-op IKDC score, while only PHS was predictive of patient satisfaction. This highlights the usefulness of SF-36 surveys prior to meniscectomy surgery. While specific Kellgren-Lawrence grades of arthritis were not significant, the presence of either patellar or lateral compartment arthritis had higher odds of obtaining pass on post-operative IKDC score. These predictive factors will help orthopedic surgeons select low-risk and appropriate patients to undergo meniscectomy, leading to improved patient outcomes.