Eric C. McCarty, MD, Kurt P. Spindler, MD, Michelle Secic, MS,
W. Grear Hurt, MD, and Elizabeth Turnipseed, BS
Objective:
Traditionally, assessment of patient function has been based on symptoms, clinical
exam findings and radiographs. The use of patient-oriented questionnaires validated
for outcome measures has only recently been employed. This study investigated
demographic, intraarticular pathology and treatment as positive outcome predictors
in 4 to 7 years after knee arthroscopy.
Methods:
The analysis consisted of 218 patients with minimum 4-year follow-up with single
unilateral knee arthroscopy (single surgeon) in a ligamentously stable knee
without other major lower extremity problems. Intraarticular knee pathology
and treatment were recorded on diagrams and forms and function follow-up was
by self-administered questionnaire which included SF-36, WOMAC, KOOS, Lysholm,
and IKDC. Both univariate and multivariate statistical analyses were performed
to determine statistically significant intraarticular and demographic variables
at intermediate follow-up with the outcomes questionnaires, global scores, subscale
scores, and functional status.
Results:
Multivariable modeling revealed gender (male) and patellar/trochlear degenerative
pathology as the only consistent statistically significant (p<0.05) independent
predictors of poor outcome with the KOOS, the IKDC, and the WOMAC scores. Other
factors found to be significant were: age (p=0.037) in the KOOS symptoms/stiffness
model, complete meniscus tear in the WOMAC stiffness (p=0.006, medial) and SF-36
Mental Health (p=0.046, lateral) models. Articular cartilage degeneration was
significant only in the MFC with advanced models. Articular cartilage degeneration
was significant only in the MFC with advanced (Grade IV) arthritis vs early
(Grade I-III) changes in the KOOS model, and for the LFC was significant in
both early and advanced in the KOOS model and in sports/recreation function,
quality of life and overall scores.
Conclusions:
The overall functional outcome after operative knee arthroscopy as assessed
by validated questionnaires is most highly correlated by articular cartilage
status, especially patellofemoral arthritis, as well as gender with males having
statistically significant worse outcomes scores than females. Meniscal treatment
did not significantly affect scores at follow-up. The results of this study
may assist the counseling of patients regarding expectations of functional outcomes
following knee arthroscopy.