Substantial Variability Exists in the Reporting of Clinically Significant Outcomes Following Meniscal Procedures: A Systematic Review

Purpose To systematically review methods of calculating and reporting thresholds of clinically significant outcome measures (CSO) associated with meniscal debridement, repair, and allograft transplantation. Methods A systematic review of PubMed, Embase, and SCOPUS online databases was conducted to identify articles reporting minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), or substantial clinical benefit (SCB) associated with procedures of the meniscus (debridement, repair or allograft transplantation) with a minimum of 12 months of follow-up published between January 1, 2010 to August 25, 2024. The MINORS criteria were used to assess study quality. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and method of CSO calculation were collected, which were then separated by procedure. Results A total of 21 studies, reporting on 3110 patients across three different meniscal procedures, were identified. Reported PROMs included Knee Injury and Osteoarthritis Outcome Score (KOOS) (n=16 studies), International Knee Documentation Committee (IKDC) (n=15 studies), Lysholm (n=12 studies), and Tegner (n=5 studies). Fifteen studies reported MCID and PASS while SCB was reported in five studies. MCID was calculated using a distribution-based methodology in nine studies using one-half of the standard deviation of the mean change. Anchor-based methods were used by nine studies reporting PASS and four reporting SCB. The most common anchor-based method was the Receiver Operating Characteristic-Youden index, utilized in six studies reporting PASS and four reporting SCB. Conclusion Substantial variability exists in the reporting and calculation of MCID, SCB, and PASS for various PROMs following meniscal debridement, repair and allograft transplantation. This heterogeneity may hinder the interpretive utility of such measures. As such, authors should strive to derive CSO values specific to their patient population at hand using anchor-based methods if possible.