Benedictus, R. (2012) Guideline Adherence 'meniscusstraat' : assessment of the adherence to the Dutch guideline for arthroscopy of the knee joint at the 'meniscusstraat' of the University Medical Center Groningen, The Netherlands. thesis, Medicine.
Full text available on request.Abstract
Introduction: There is a high incidence of knee-injuries in Dutch general practice, with an incidence of acute meniscal injury of 2 per 1000 patients. The menisci are structures in the knee joints, whose principal functions are load transmission and shock absorption. Tearing of the meniscus can occur after abnormal rotational force in the weight-bearing knee or gradually if there are degenerative changes of the meniscal tissue. The management of meniscal tears can be conservative (mainly strengthening of leg-muscles to create stability in the knee joint) or surgical by arthroscopy (repair, resection, transplantation). The Dutch Orthopedic Society initiated the development of a Dutch guideline for arthroscopy of the knee joint. Since 2009 the University Medical Centre Groningen has streamlined the treatment of knee-injuries in the so called ‘Meniscusstraat’. Objective: The objective of this study is to determine if the management of patients of the ‘Meniscusstraat’ is according to the Dutch guideline for arthroscopy of the knee joint and whether or not there have been unnecessary arthroscopies and/or MRI’s. Methods: In this retrospective case-referent study, the visits of the first 150 unique patients of the ‘Meniscusstraat’ in 2011 were assessed. Each visit was assigned to a group (watchful waiting, conservative, MRI, arthroscopy), based on the actual management path (observed group). With information from the medical charts the visits were then reassessed based on the recommendations from the Dutch guideline for arthroscopy of the knee joint, and assigned to 1 of the 4 management path groups (virtual group). If the observed and the virtual management path were similar, it was considered to be according to the guideline. Information about the radiological findings from MRI’s and indications for arthroscopies and given treatment were gathered for evaluation. Results: Of the 241 assessed visits, 211 were according to the guideline. Statistical analysis with Pearson’s Chi-Square test showed this difference was significant (P = 0.000). MR-imaging was requested by the ‘Meniscusstraat’ in 73 cases, of which 50 (68.5%) showed intra articular injury. In this study 45 patients underwent an arthroscopy, a meniscal tear was the most common indication (39/86.7%), the most common therapy given was a meniscectomy (31/68.9%) and in 10 (20.2%) cases there was no therapy given. Discussion: The statistical analysis shows that the ‘Meniscusstraat’ does not adhere to the Dutch guideline for arthroscopy of the knee joint. However, closer inspection of the largest contributors reveals that these results are clouded by the fact that some decisions made by the physician are because a patients’ wishes and the patient-tailored approach of the ‘Meniscusstraat’. The number of unnecessary performed MRI’s and arthroscopies are within the expected range. Because of the retrospective design of this study, assessment of the visits was limited. This study should therefore be considered explorative in nature, a more standardized assessment of the visits is needed to formulate a reliable conclusion.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Diercks, Prof. dr. R. L. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:01 |
| Last Modified: | 25 Jun 2020 11:01 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2171 |
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