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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2022; 57(06): 1014-1021
DOI: 10.1055/s-0041-1740470
Artigo Original
Joelho

Medidas de desfechos clínicos na meniscectomia artroscópica: Pontuações de joelho segundo médicos e pacientes

Article in several languages: português | English
Oday Al-Dadah 
1   Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle-upon-Tyne, Reino Unido
2   Departamento de Trauma e Cirurgia Ortopédica, South Tyneside Hospital, Harton Lane, South Tyneside, Reino Unido
,
Lee Shepstone
3   Medical School, University of East Anglia, Earlham Road, Norwich, Reino Unido
,
Simon T. Donell
3   Medical School, University of East Anglia, Earlham Road, Norwich, Reino Unido
› Author Affiliations Financiamento O presente estudo foi financiado pelo Gwen Fish Charity Trust, pelo Norfolk and Norwich University Hospital Research Fund e pelo Action Arthritis Charity Trust.
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Resumo

Objetivo O objetivo do presente estudo foi investigar a diferença entre instrumentos de desfechos preenchidos por médicos e pacientes na detecção de melhora após a meniscectomia artroscópica para tratamento de rupturas de menisco.

Métodos Trinta e quatro pacientes com rupturas de menisco foram avaliados de forma prospectiva usando 9 medidas de desfechos clínicos. Os cinco instrumentos de avaliação de joelho respondidos por médicos foram o Escore de Atividade de Tegner, o Escore de Joelho de Lysholm, o Escore de Joelho de Cincinnati, o Escore de Exame do Joelho do International Knee Documentation Committee (IKDC, na sigla em inglês) e o Escore de Classificação do Menisco de Tapper e Hoover. Os quatro instrumentos de avaliação do joelho respondidos por pacientes foram o Escore Subjetivo do Joelho do IKDC, a Pesquisa de Desfecho de Joelho – Escala de Atividades de Vida Diária (KOS-ADLS, na sigla em inglês), o Formulário Curto de Pesquisa em Saúde de 12 Itens (SF-12, na sigla em inglês) e o Escore de Desfecho de Osteoartrite e Lesões no Joelho (KOOS, na sigla em inglês). Vinte e nove dos 34 pacientes foram submetidos a uma meniscectomia artroscópica e reavaliados com todos os 9 instrumentos na sua consulta de acompanhamento.

Resultados Uma melhora longitudinal significativa foi observada em 4 dos 5 instrumentos respondidos por médicos (Tegner [p < 0,001], Lysholm [p = 0,004], Cincinnati [p = 0,002] e Tapper e Hoover [p < 0,001], mas não no IKDC [p = 0,332]). Por outro lado, o Escore Subjetivo do Joelho do IKDC (p = 0,021) foi o único instrumento respondido por pacientes a demonstrar melhora pós-operatória significativa.

Conclusão De modo geral, os instrumentos respondidos por médicos foram considerados inconsistentes em relação àqueles respondidos por pacientes. O modo de administração dos instrumentos pode ter influência significativa nos resultados, tanto para fins de pesquisa quanto para a prática clínica. A combinação de um instrumento respondido pelo médico com um instrumento respondido pelo paciente pode ser uma abordagem mais equilibrada para a avaliação e a quantificação das rupturas do menisco e do desfecho após a meniscectomia artroscópica.

Palavras-chave

menisco - meniscectomia - medidas de resultados relatados pelo paciente - escore de Lysholm para joelho


Publication History

Received: 05 April 2021

Accepted: 13 August 2021

Article published online:
21 January 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Kise NJ, Risberg MA, Stensrud S, Ranstam J, Engebretsen L, Roos EM. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients: randomised controlled trial with two year follow-up. BMJ 2016; 354: i3740
    CrossrefPubMedGoogle Scholar
  • 2 Sihvonen R, Paavola M, Malmivaara A. et al. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial. Br J Sports Med 2020; 54 (22) 1332-1339
    CrossrefPubMedGoogle Scholar
  • 3 Sihvonen R, Paavola M, Malmivaara A. et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369 (26) 2515-2524
    CrossrefPubMedGoogle Scholar
  • 4 Thorlund JB, Juhl CB, Roos EM, Lohmander LS. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 2015; 350: h2747
    CrossrefPubMedGoogle Scholar
  • 5 Abram SGF, Beard DJ, Price AJ. BASK Meniscal Working Group. Arthroscopic meniscal surgery: a national society treatment guideline and consensus statement. Bone Joint J 2019; 101-B (06) 652-659
    CrossrefPubMedGoogle Scholar
  • 6 Beaufils P, Becker R, Kopf S. et al. Surgical management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 2017; 25 (02) 335-346
    CrossrefPubMedGoogle Scholar
  • 7 The National Joint Registry - Patient Reported Outcome Measures. Available from: https://www.njrcentre.org.uk/njrcentre/Research/NJR-PROMs
  • 8 Tapper EM, Hoover NW. Late results after meniscectomy. J Bone Joint Surg Am 1969; 51 (03) 517-526
    CrossrefPubMedGoogle Scholar
  • 9 Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the Lysholm knee score and Tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006; 88 (04) 698-705
    Google Scholar
  • 10 Mintzer CM, Richmond JC, Taylor J. Meniscal repair in the young athlete. Am J Sports Med 1998; 26 (05) 630-633
    CrossrefPubMedGoogle Scholar
  • 11 Roos EM, Roos HP, Ekdahl C, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS)–validation of a Swedish version. Scand J Med Sci Sports 1998; 8 (06) 439-448
    CrossrefPubMedGoogle Scholar
  • 12 Irrgang JJ, Snyder-Mackler L, Wainner RS, Fu FH, Harner CD. Development of a patient-reported measure of function of the knee. J Bone Joint Surg Am 1998; 80 (08) 1132-1145
    CrossrefPubMedGoogle Scholar
  • 13 Katz JN, Harris TM, Larson MG. et al. Predictors of functional outcomes after arthroscopic partial meniscectomy. J Rheumatol 1992; 19 (12) 1938-1942
    Google Scholar
  • 14 Cole BJ, Dennis MG, Lee SJ. et al. Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Am J Sports Med 2006; 34 (06) 919-927
    CrossrefPubMedGoogle Scholar
  • 15 Koyonos L, Yanke AB, McNickle AG. et al. A randomized, prospective, double-blind study to investigate the effectiveness of adding DepoMedrol to a local anesthetic injection in postmeniscectomy patients with osteoarthritis of the knee. Am J Sports Med 2009; 37 (06) 1077-1082
    CrossrefPubMedGoogle Scholar
  • 16 Marx RG, Jones EC, Allen AA. et al. Reliability, validity, and responsiveness of four knee outcome scales for athletic patients. J Bone Joint Surg Am 2001; 83 (10) 1459-1469
    CrossrefPubMedGoogle Scholar
  • 17 Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ. International Knee Documentation Committee. The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 2006; 34 (01) 128-135
    CrossrefPubMedGoogle Scholar
  • 18 Irrgang JJ, Anderson AF, Boland AL. et al. Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 2001; 29 (05) 600-613
    CrossrefPubMedGoogle Scholar
  • 19 Pujol N, Panarella L, Selmi TA, Neyret P, Fithian D, Beaufils P. Meniscal healing after meniscal repair: a CT arthrography assessment. Am J Sports Med 2008; 36 (08) 1489-1495
    CrossrefPubMedGoogle Scholar
  • 20 Al-Dadah O, Shepstone L, Donell ST. Clinical outcome measures in anterior cruciate ligament reconstruction: Clinician vs patient completed knee scores. Surgeon 2021; 19 (06) e353-e360
    CrossrefPubMedGoogle Scholar
  • 21 Cameron ML, Briggs KK, Steadman JR. Reproducibility and reliability of the outerbridge classification for grading chondral lesions of the knee arthroscopically. Am J Sports Med 2003; 31 (01) 83-86
    CrossrefPubMedGoogle Scholar
  • 22 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (04) 456-460
    CrossrefPubMedGoogle Scholar
  • 23 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
    CrossrefPubMedGoogle Scholar
  • 24 Outerbridge RE, Dunlop JA. The problem of chondromalacia patellae. Clin Orthop Relat Res 1975; (110) 177-196
    CrossrefPubMedGoogle Scholar
  • 25 Spindler KP, Warren TA, Callison Jr JC, Secic M, Fleisch SB, Wright RW. Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 2005; 87 (08) 1673-1679
    Google Scholar
  • 26 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedGoogle Scholar
  • 27 Bentley G, Biant LC, Carrington RW. et al. A prospective, randomised comparison of autologous chondrocyte implantation versus mosaicplasty for osteochondral defects in the knee. J Bone Joint Surg Br 2003; 85 (02) 223-230
    CrossrefPubMedGoogle Scholar
  • 28 Noyes FR, Barber SD, Mangine RE. Bone-patellar ligament-bone and fascia lata allografts for reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 1990; 72 (08) 1125-1136
    CrossrefPubMedGoogle Scholar
  • 29 Noyes FR, Barber SD, Mooar LA. A rationale for assessing sports activity levels and limitations in knee disorders. Clin Orthop Relat Res 1989; (246) 238-249
    PubMedGoogle Scholar
  • 30 Forms IKDC. The American Orthopaedic Society for Sports Medicine. 2000 Available from: http://www.sportsmed.org/tabs/research/ikdc.aspx
    PubMedGoogle Scholar
  • 31 Hefti F, Müller W, Jakob RP, Stäubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1993; 1 (3-4): 226-234
    CrossrefPubMedGoogle Scholar
  • 32 Irrgang JJ, Anderson AF. Development and validation of health-related quality of life measures for the knee. Clin Orthop Relat Res 2002; (402) 95-109
    CrossrefPubMedGoogle Scholar
  • 33 Ware Jr J, Kosinski M, Keller SDA. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34 (03) 220-233
    CrossrefPubMedGoogle Scholar
  • 34 Roos EM, Lohmander LS. The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes 2003; 1: 64
    CrossrefPubMedGoogle Scholar
  • 35 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)–development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    CrossrefPubMedGoogle Scholar