Determining the Minimal Clinically Important Difference on the Oxford Shoulder Instability Score in Patients Undergoing Arthroscopic Bankart Repair for Shoulder Instability

Foong, Wei Sheng; Zeng, Gerald Joseph; Goh, Graham S.; Ying, Hao; Lie, Denny; Chang, Paul Chee Cheng

doi:10.1177/23259671211060023

Cited by 9 publications

(8 citation statements)

References 49 publications

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“…Only a few studies have attempted to define MCID values for anterior shoulder instability, all after arthroscopic Bankart repair and without considering PASS. 8,23,24 The present study is among the first to define clinically relevant states (MCID and PASS) across various PROs after open Latarjet. Park et al 23 calculated MCID for the Rowe and WOSI scores in 198 patients undergoing arthroscopic Bankart repair.…”

Section: Discussionmentioning

confidence: 94%

“…24 A recent study published in January 2022 reported MCID values using both anchor-based and distribution-based (0.20 effect size) methods for the Oxford Shoulder Instability Score, yielding values ranging from 7.7 to 8.6. 8…”

Section: Discussionmentioning

confidence: 99%

“…24 A recent study published in January 2022 reported MCID values using both anchor-based and distributionbased (0.20 effect size) methods for the Oxford Shoulder Instability Score, yielding values ranging from 7.7 to 8.6. 8 Currently, there is no standard method for determining MCID. 23 In our study, the half-SD method of calculating the MCID was used, based on previous evidence that the threshold of discrimination for changes in most healthrelated quality-of-life instruments is approximately half an SD.…”

Section: Discussionmentioning

confidence: 99%

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Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

et al. 2022

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Background: The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined. Purpose: This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS. Study Design: Case series; Level of evidence, 4. Methods: A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion). Results: A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS. Conclusion: This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

et al. 2022

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“…The minimal clinically important difference was 8.5 for the ASES score, 51 9.7 for the Rowe score, 51 and 8.6 for the OSIS. 29 General satisfaction with the clinical outcomes of surgery was rated on a 5-level scale as very satisfied, satisfied, neutral, dissatisfied, and very dissatisfied. 49 Active shoulder ROM was measured, including forward flexion, external rotation (at both 0° and 90° of abduction), and internal rotation (recorded as the highest vertebral level that could be reached with the patient’s thumb).…”

Section: Methodsmentioning

confidence: 99%

Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Fang

et al. 2022

Am J Sports Med

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Background: As an alternative to the Latarjet procedure, the arthroscopic free bone block (FBB) procedure combined with dynamic anterior stabilization (DAS) has been recently proposed to provide both glenoid augmentation and a tendon sling effect for treating anterior shoulder instability (ASI) with glenoid bone loss. Purpose: To evaluate the clinical and radiological outcomes of FBB-DAS for ASI with glenoid bone loss. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic FBB-DAS for ASI with >15% glenoid bone loss between February 2017 and March 2020 were screened and enrolled in this study. Clinical outcome measures were assessed preoperatively and at a minimum 2-year follow-up, including recurrence, complications, shoulder functional scores, range of motion, and return to sports. Postoperative computed tomography and magnetic resonance imaging were also performed. Results: Of a total of 65 patients with a mean follow-up of 46.1 ± 13.1 months, no patients experienced a recurrent dislocation or subluxation postoperatively, while 2 had a positive anterior apprehension test (3.1%). Additionally, 2 patients (3.1%) experienced complications of hematoma and shoulder stiffness, respectively. The mean visual analog scale score, American Shoulder and Elbow Surgeons score, Rowe score, and Oxford Shoulder Instability Score all improved significantly from 3.2 ± 2.4, 75.0 ± 18.9, 43.6 ± 27.3, and 33.8 ± 9.0 preoperatively to 1.3 ± 0.8, 95.1 ± 8.0, 95.5 ± 7.8, and 14.8 ± 3.5 at final follow-up, respectively (all P < .001). No difference was detected in range of motion except for 8.1° and 7.5° external rotation limitations in adduction and abduction, respectively. There were 62 patients (95.4%) who returned to sports, and 54 patients (83.1%) returned to the preinjury level. The transferred biceps tendon was intact in all 59 patients who completed radiological examination at the latest follow-up. Good bone healing was achieved in 98.3% of patients, and the glenoid bone defect decreased from 18.1% to 4.9%. Osseous and labral glenoids were significantly enlarged in width and depth on the latest magnetic resonance imaging (all P < .001). Conclusion: Arthroscopic FBB-DAS provided satisfactory clinical and radiological outcomes for ASI with glenoid bone loss. Despite slight external rotation restrictions, it achieved low recurrence and complication rates, excellent shoulder functional scores, a high return-to-sports rate, and favorable graft healing and remodeling.

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“…20,27,28,40 Previous studies have defined MCID values for the Rowe score, the Western Ontario Shoulder Instability Index, and the Oxford Shoulder Instability Score after ABR. 11,29 Despite this, no studies have attempted to identify MCID values for the ASOSS score or PASS thresholds for the Rowe and ASOSS scores, which are 2 frequently used scores in glenohumeral instability research. 3 The MCID and PASS thresholds have demonstrated marked variation based on patient characteristics, type of intervention, preoperative diagnosis, and method of estimation, which may result in over-or underestimation of failure to improve.…”

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confidence: 99%

Effect of Patient Characteristics on the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds After Arthroscopic Bankart Repair

Pasqualini,

Tanoira,

Hurley

et al. 2024

Am J Sports Med

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Background: There is scarce literature on clinically significant values after arthroscopic Bankart repair (ABR). Purpose: To determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) thresholds at 1 year for the Rowe and Athletic Shoulder Outcome Scoring System (ASOSS) scores after ABR and to determine the effect of patient characteristics on these metrics after ABR. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of patients undergoing ABR from a single institution between January 2017 and January 2020 was performed. Patients with at least 1 episode of instability and a minimum follow-up of 12 months were included. The exclusion criteria were as follows: bony defects of >20% on the anteroinferior portion of the glenoid based on a preoperative computed tomography scan; engaging Hill-Sachs lesions at 90° of abduction and 90° of external rotation based on an arthroscopic examination; previous surgery on the same shoulder; multidirectional instability or concomitant repair of full-thickness rotator cuff tears; superior labral anterior to posterior lesions; posterior labral tears; or humeral avulsion of the glenohumeral ligament lesions. Patient-reported outcome measures were collected both preoperatively and 1-year postoperatively. Delta was defined as the change between preoperative and 1-year postoperative scores. Distribution-based (one-half the standard deviation of the difference between pre- and postoperative outcome scores) and anchored-based approaches (response to a satisfaction question at 1 year) were used to estimate the MCID and the PASS, respectively. The optimal cutoff point, where sensitivity and specificity were maximized, and the percentage of patients achieving those thresholds were also calculated. Results: Overall, 190 patients were included. The distribution-based MCID for the Rowe and ASOSS scores were calculated to be 8.2 and 8.7, respectively. The rate of patients who achieved MCID thresholds was 96% for the Rowe and 96% for ASOSS scores. The PASS threshold for the Rowe and ASOSS scores were ≥80 and ≥90, respectively. The rate of patients who achieved PASS scores after ABR were 86% and 83%, respectively. The MCID and PASS values showed great variability based on sex (men: 8.5 and ≥85 for Rowe / 8.9 and ≥90 for ASOSS, respectively, vs women: 6.7 and ≥73 for Rowe / 8.1 and ≥75 for ASOSS), age (≥21: 8.4 and ≥80 / 9.2 and ≥90 vs <21: 7.8 and ≥75 / 7.7 and ≥85), sports participation (sports: 8.8 and ≥85 / 9.5 and ≥90 vs no sports: 8.1 and ≥75 / 8.6 and ≥80), and type of athlete (competitive: 8.4 and ≥85 / 8.9 and ≥87 vs recreational: 7.5 and ≥73 / 8.1 and ≥68). Conclusion: This study identified the MCID and PASS thresholds for the Rowe and ASOSS scores at 1 year after ABR. However, these values showed great variability when accounting for different patient characteristics such as sex, age, sports participation, and type of athlete, highlighting the importance of considering individual patient-specific characteristics for optimal treatment decision-making and ensuring treatment success tailored to each patient’s unique needs and expectations.

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Determining the Minimal Clinically Important Difference on the Oxford Shoulder Instability Score in Patients Undergoing Arthroscopic Bankart Repair for Shoulder Instability

Cited by 9 publications

References 49 publications

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

Clinical and Radiological Outcomes in Patients With Anterior Shoulder Instability and Glenoid Bone Loss after Arthroscopic Free Bone Block Combined With Dynamic Anterior Stabilization

Effect of Patient Characteristics on the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds After Arthroscopic Bankart Repair

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