Thanks very much. My disclosures are available through the online disclosure program. So arthroscopic meniscectomy represents one of the most common procedures performed in orthopedics. However, recent studies have called into question the clinical efficacy of the procedure and resulted in significant media attention. Defining the time that it's required for one to reach a clinically significant outcome after a partial meniscectomy is important in that it helps us to determine post-operative follow-up timelines, meaning how long do we have to follow these patients. It helps us to optimize value-based care structures and also inform patients in a shared model about how long they can expect to see improvement. Now we've moved over the last decade from using statistical significance to now using clinical significance in our outcome measures. And we primarily do this with things like MCID, which is the smallest outcome change that is appreciable by the patient. Initial clinical benefit, which is the outcome improvement that a patient recognizes as considerable. And probably the most important, which is a pass, the health outcome state at which the patient is satisfied with their outcome. So the purpose of this study was to determine the time required to achieve some of these clinically significant outcome measures and to identify preoperative and intraoperative as well as post-operative factors that may predict either early or delayed achievement. Our hypothesis was that partial meniscectomy patients would have the greatest probability of achieving clinically significant outcome by six months and would decrease in time thereafter and that age and specific pathologies may predict either earlier or delayed recovery. We used a prospective database of serial collection of operative patients, all arthroscopic partial meniscectomies between 2014 and 2017. Our clinically significant outcomes were determined using an anchor-based method. We looked primarily at IKDC and COOS and its subscores. We included all patients that had serial completion of outcomes over time. We excluded revision procedures, significant concomitant procedures, or patients that did not complete serial outcome measures. We ended up with 126 patients. You can see their demographic data here. 14% went on to some form of revision surgery, most commonly either an arthroplasty or revision arthroscopy. And here you can see some of the preoperative, operative, and post-operative characteristics that were evaluated in terms of predicting time to clinically significant outcomes. Most of our tears were traumatic versus degenerative. This was defined as a patient presenting with an acute onset of pain associated with an injury. Medial tears were more common than lateral, and most of our tears were either degenerative or complex in nature. If we look at when patients achieved a clinically significant outcome, about two-thirds would achieve this by six months, and 95% of all of those that would eventually achieve a clinically significant outcome did so by one year. And this was true for IKDC, as well as true across all of our different patient-reported outcome measures that were used, including all of the COOS subsets, as you see here. In terms of the rates of achievement of MCID, this was the one that was probably most surprising to me, is that only about 50% to 68% of patients, depending on which subscore you used, actually achieved a patient-acceptable asymptomatic state. And the mean time to achievement was about six months for all of the measures in question. Some of the predictors, age was a little bit of a surprising one in that it was an early predictor of MCID. This may be because we were more appropriate with our indications in older patients. Medial tears did better in terms of pass, and delayed was either root tears or post-operative steroid injections that predicted a delayed timeframe for achieving any of these clinically significant measures. I think that the study does have some implications in terms of healthcare policy and how long we need to follow these patients as we move to quality-derived metrics. The question is, how long do those metrics need to be reported as? And certainly for outcome study design, at meetings such as this or based on our publications, we're often hung up on this dogma that we have to have two-year follow-up in order to report clinically relevant outcomes. That may be true if we're going to look at things like progression of arthritis or conversion for arthroplasty in the future, but some of these procedures are probably the outcome is known by as early as six months to a year. There are some clinical questions raised by the work. So again, only 50% to 68% of patients, depending on the measure that you used, actually reached a patient-acceptable state. And I think as a society of arthroscopists, we need to start to ask questions about who are the most appropriate patients for arthroscopic meniscectomy. Some of the limitations, meniscectomy data was collected across five surgeons, but that's probably more representative of a general population. Patient compliance is always challenging with these patient-reported outcome measures and may lead to some selection bias in terms of who's actually completing their measures. And follow-up data was only completed at defined time periods. So it's difficult for us to say with any granularity if CSOs were obtained either earlier or somewhere between six months and 12 years. So in conclusion, the majority of patients undergoing partial meniscectomy will achieve an outcome by six months and almost all by one year. And there are some factors that predict either earlier or delayed achievement. Thanks very much. Thank you.

arthroscopic meniscectomy

clinical efficacy

orthopedic procedure

post-operative follow-up

recovery time