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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

09-11-2023 | SHOULDER

Time required to achieve clinically significant outcomes after arthroscopic superior capsular reconstruction

Authors: Hui Ben, Chu Hui Zeng, Erica Kholinne, Seung Min Ryu, Jian Loong Ling, Kyoung-Hwan Koh, In-Ho Jeon

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Abstract

Purpose

To investigate the time-dependent nature of clinically significant outcomes, including the minimal clinically important difference (MCID), substantial clinical benefit, and Patient Acceptable Symptomatic State (PASS) after arthroscopic superior capsular reconstruction, and the factors contributing to the achievement of early clinically significant outcomes.

Methods

Patients who underwent ASCR between March 2015 and September 2020 with complete preoperative and postoperative 6-month, 1-year, and 2-year patient-reported outcome measures (PROMs) were retrospectively analysed. Threshold values for MCID, substantial clinical benefit, and PASS were obtained from the previous literature for the PROMs. The time required to achieve clinically significant outcomes was calculated using Kaplan–Meier analysis. Multivariate Cox regression was performed to evaluate the variables predictive of an earlier or delayed achievement of MCID.

Results

Fifty-nine patients with a mean age of 64.5 ± 8.7 years old were included. The time of mean achievement of MCID, substantial clinical benefit, and PASS for VAS was 11.2 ± 0.9, 16.3 ± 1.1, and 16.6 ± 0.9 months, respectively. The time of mean achievement of MCID, substantial clinical benefit, and PASS for ASES was 13.2 ± 1.0, 16.8 ± 1.0, and 18.3 ± 0.9 months, respectively. The time of mean achievement of MCID, substantial clinical benefit, and PASS for the Constant score was 11.6 ± 0.9, 15.1 ± 1.0, and 14.7 ± 0.9 months, respectively. The time of mean achievement of MCID, substantial clinical benefit, and PASS for SANE was 14.4 ± 1.0, 16.1 ± 1.0, and 15.5 ± 0.8 months, respectively. Patients with a higher preoperative VAS score achieved an earlier MCID for VAS (P = 0.014). However, patients with a higher preoperative ASES and SANE scores achieved delayed MCID for ASES and SANE (P = 0.026, and P < 0.001, respectively).

Conclusion

Most patients achieved MCIDs around 1 year after arthroscopic superior capsular reconstruction. A higher preoperative VAS score favours faster MCID achievement, while higher preoperative ASES and SANE scores contribute to delayed MCID achievement.

Study design

Cohort study

Level of evidence

Level IV.

Alben MG, Gordon D, Gambhir N, Kim MT, Romeo PV, Rokito AS et al (2023) Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs. Knee Surg Sports Traumatol Arthrosc 31:2602–2614CrossRefPubMed

Ban I, Troelsen A, Kristensen MT (2016) High inter-rater reliability, agreement, and convergent validity of Constant score in patients with clavicle fractures. J Shoulder Elbow Surg 25:1577–1582CrossRefPubMed

Ben H, Kholinne E, Lee JB, So SP, Zeng CH, Koh KH et al (2023) Postoperative MRI signal intensity correlates functional outcomes after superior capsular reconstruction. Knee Surg Sports Traumatol Arthrosc 31:1903–1909CrossRefPubMed

Ben H, Kholinne E, Zeng CH, So SP, Lee JB, Sun Y et al (2023) Early Postoperative MRI evaluation of a fascia lata autograft with and without polypropylene mesh augmentation after superior capsular reconstruction. Am J Sports Med 51:912–918CrossRefPubMed

Cole BJ, Cotter EJ, Wang KC, Davey A (2017) Patient understanding, expectations, outcomes, and satisfaction regarding anterior cruciate ligament injuries and surgical management. Arthroscopy 33:1092–1096CrossRefPubMed

Croci E, Warmuth F, Baum C, Kovacs BK, Nuesch C, Baumgartner D et al (2023) Load-induced increase in muscle activity during 30 degrees abduction in patients with rotator cuff tears and control subjects. J Orthop Traumatol 24:41CrossRefPubMedPubMedCentral

Degan TJ, Hartzler RU, Rahal A, DeBerardino TM, Burkhart SS (2022) Prospective 1-year outcomes are maintained at short-term final follow-up after superior capsular reconstruction augmentation of complete rotator cuff repair. Arthroscopy 38:1411–1419CrossRefPubMed

Evuarherhe A Jr, Condron NB, Gilat R, Knapik DM, Patel S, Wagner KR et al (2022) Defining clinically significant outcomes following superior capsular reconstruction with acellular dermal allograft. Arthroscopy 38(1444–1453):e1441

Forsythe B, Patel HH, Berlinberg EJ, Forlenza EM, Okoroha KR, Williams BT et al (2023) A radiostereometric analysis of tendon migration after arthroscopic and mini-open biceps tenodesis: interference screw versus single suture anchor fixation. Am J Sports Med 51:2869–2880CrossRefPubMed

10.

Hamid KS, Nwachukwu BU, Bozic KJ (2017) Decisions and incisions: a value-driven practice framework for academic surgeons. J Bone Jt Surg Am 99:e50CrossRef

11.

Hammad AM, Phillips C, Wijdicks CA, Adams CR, Denard PJ (2022) Two-year retrospective patient-reported outcomes following superior capsular reconstruction. Arthroscopy 38:262–266CrossRefPubMed

12.

Harris JD, Brand JC, Cote MP, Dhawan A (2017) Research pearls: the significance of statistics and perils of pooling. Part 3: pearls and pitfalls of meta-analyses and systematic reviews. Arthroscopy 33:1594–1602CrossRefPubMed

13.

Hirschmann MT, Wind B, Amsler F, Gross T (2010) Reliability of shoulder abduction strength measure for the Constant–Murley score. Clin Orthop Relat Res 468:1565–1571CrossRefPubMed

14.

Jackson GR, Tuthill T, Schundler SF, Condon JJ, Salazar LM, Nwiloh M et al (2023) acellular dermal allograft and tensor fascia lata autograft show similar patient outcome improvement and high rates of complications and failures at a minimum two-year follow-up: a systematic review. Arthroscopy. https://doi.org/10.1016/j.arthro.2023.01.003CrossRefPubMed

15.

Katz NP, Paillard FC, Ekman E (2015) Determining the clinical importance of treatment benefits for interventions for painful orthopedic conditions. J Orthop Surg Res 10:24CrossRefPubMedPubMedCentral

16.

Kearney M, Jennrich MK, Lyons S, Robinson R, Berger B (2011) Effects of preoperative education on patient outcomes after joint replacement surgery. Orthop Nurs 30:391–396CrossRefPubMed

17.

Kholinne E, Kwak JM, Cho CH, AlSomali K, Van Nguyen T, Kim H et al (2021) Arthroscopic superior capsular reconstruction for older patients with irreparable rotator cuff tears: a comparative study with younger patients. Am J Sports Med 49:2751–2759CrossRefPubMed

18.

Kholinne E, Kwak JM, Kim H, Koh KH, Jeon IH (2020) Arthroscopic superior capsular reconstruction with mesh augmentation for the treatment of irreparable rotator cuff tears: a comparative study of surgical outcomes. Am J Sports Med 48:3328–3338CrossRefPubMed

19.

Kim YK, Jung KH, Choi KY, Kang SW, Choi RJ (2023) Arthroscopic superior capsular reconstruction with tensor fascia lata allograft for irreparable rotator cuff tears: clinical and radiologic outcomes for a minimum 1-year follow-up. Arthroscopy. https://doi.org/10.1016/j.arthro.2022.12.037CrossRefPubMed

20.

Lee JB, Kholinne E, Yeom JW, Ben H, AlAhmadi BM, Koh KH et al (2022) Effect of fatty infiltration of the infraspinatus muscle on outcomes and graft failure after arthroscopic superior capsule reconstruction for irreparable posterosuperior rotator cuff tears. Am J Sports Med 50:3907–3914CrossRefPubMed

21.

Mahatme RJ, Modrak M, Wilhelm C, Lee MS, Owens JS, Gillinov SM et al (2023) Glenohumeral superior translation and subacromial contract pressure are both improved with superior capsular reconstruction: a systematic review and meta-analysis of biomechanical investigations. Arthroscopy. https://doi.org/10.1016/j.arthro.2023.08.025CrossRefPubMed

22.

Manderle BJ, Gowd AK, Liu JN, Beletsky A, Nwachukwu BU, Nicholson GP et al (2020) Time required to achieve clinically significant outcomes after arthroscopic rotator cuff repair. Am J Sports Med 48:3447–3453CrossRefPubMed

23.

Muench LN, Dyrna F, Otto A, Wellington I, Obopilwe E, Scheiderer B et al (2023) Superior capsular reconstruction partially restores native glenohumeral joint loads in a dynamic biomechanical shoulder model. Arthroscopy 39:1781–1789CrossRefPubMed

24.

Nwachukwu BU, Chang B, Adjei J, Schairer WW, Ranawat AS, Kelly BT et al (2018) Time required to achieve minimal clinically important difference and substantial clinical benefit after arthroscopic treatment of femoroacetabular impingement. Am J Sports Med 46:2601–2606CrossRefPubMed

25.

Pashuck TD, Hirahara AM, Cook JL, Cook CR, Andersen WJ, Smith MJ (2021) Superior capsular reconstruction using dermal allograft is a safe and effective treatment for massive irreparable rotator cuff tears: 2-year clinical outcomes. Arthroscopy 37(489–496):e481

26.

Rihn JA, Currier BL, Phillips FM, Glassman SD, Albert TJ (2013) Defining the value of spine care. J Am Acad Orthop Surg 21:419–426PubMed

27.

Shin SJ, Lee S, Hwang JY, Lee W, Koh KH (2022) Superior capsular reconstruction using acellular dermal allograft combined with remaining rotator cuff augmentation improved shoulder pain and function at 1 year after the surgery. Arthroscopy 38:1089–1098CrossRefPubMed

28.

Yeom JW, Kim DM, Lee JB, Ben H, Alahmadi BM, Park JH et al (2022) Patient acceptable symptom state, minimal clinically important difference, and substantial clinical benefit after arthroscopic superior capsular reconstruction. Am J Sports Med 50:3308–3317CrossRefPubMed

Title: Time required to achieve clinically significant outcomes after arthroscopic superior capsular reconstruction
Authors: Hui Ben
Chu Hui Zeng
Erica Kholinne
Seung Min Ryu
Jian Loong Ling
Kyoung-Hwan Koh
In-Ho Jeon
Publication date: 09-11-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07649-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time required to achieve clinically significant outcomes after arthroscopic superior capsular reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Study design

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Study design

Level of evidence

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