Clinically meaningful thresholds in patient-reported outcome measures (PROMs) for arthroscopic meniscal surgery: A systematic review with narrative synthesis.

Abstract

Certain metrics such as the Minimal Clinically Important Difference (MCID), Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom State (PASS) now exist to help interpret any change in Patient-Reported Outcome Measure (PROM) score. However, few studies have defined these thresholds for commonly-used PROMs after meniscal surgery. The aim was to summarise these values and identify factors associated with achievement of the scores. MEDLINE and Embase databases (from inception to December 2025) were searched using keywords. Studies that calculated the MCID, SCB or PASS for any PROM in patients undergoing arthroscopic meniscal surgery (repair or partial meniscectomy) were included. 372 articles were screened and 10 studies (all Level 3 evidence), involving 3436 patients, fulfilled the inclusion criteria. All studies assessed patients undergoing partial meniscectomy, with two also looking at meniscal repair. Seven different PROMs (including subtypes) were investigated with the KOOS (n = 7) having the most threshold values reported for. MCID scores were reported in nine studies, SCB in three and PASS in six. For the most common PROM (KOOS), MCID values ranged from 6.4 to 10.4 (Symptoms subtype), 1.4-12 (Pain), 3.7-12 (ADL), 11.8-18.4 (Sport) and 3.1-15.6 (QoL). Similar variability was observed for PASS. Several patient-centred metrics for arthroscopic meniscal surgery have been studied. However, there is significant variability in the threshold scores calculated for MCID, SCB and PASS. Heterogeneity in study populations, study duration and calculation methods may have led to such differences. Clinicians should exercise caution when they interpret their data based off these published values.