Postoperative MRI signal intensity correlates functional outcomes after superior capsular reconstruction

Ben, Hui; Kholinne, Erica; Lee, Jun-Bum; So, Sang-Pil; Zeng, Chu Hui; Koh, Kyoung-Hwan

doi:10.1007/s00167-022-07111-2

Cited by 5 publications

(8 citation statements)

References 29 publications

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“…Kholinne et al 20,21 also reported that arthroscopic SCR with mesh augmentation contributed to better clinical outcomes and lowered graft failure rate than SCR without a mesh. Ben et al 3 also reported that the SNQ of the FLA was negatively correlated with clinical outcomes after SCR. In this study, better healing of grafts with mesh augmentation as indicated by lower SNQs was found, which may explain the improved outcomes with the use of an FLA with mesh augmentation.…”

Section: Discussionmentioning

confidence: 96%

“…Li et al 30 reported that postoperative residual pain was associated with higher SNQs of the repaired supraspinatus tendon. Ben et al 3 found that worse clinical outcomes were correlated with higher SNQs of the FLA after SCR.…”

Section: Discussionmentioning

confidence: 99%

“…The signal-to-noise quotient (SNQ), calculated by the graft signal intensity on MRI, has been widely used to evaluate graft remodeling. 3,7,10,28,33,45,47 In general, a lower SNQ indicates higher tensile strength of the graft. 42,45 To date, no study has been conducted to evaluate the potential effect of the use of a mesh on an FLA in vivo after SCR.…”

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confidence: 99%

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Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

et al. 2023

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Background: Recently, a polypropylene mesh has been introduced and reported to improve clinical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft (FLA). However, mesh-related events such as a foreign body response may trigger inflammation, which might affect graft healing and remodeling. Purpose/Hypothesis: The aim was to investigate whether the healing and remodeling of an FLA were affected by the use of a mesh by comparing the signal intensity of an FLA-alone group vs an FLA + Mesh group on postoperative magnetic resonance imaging (MRI). The hypothesis was that the use of a mesh would decrease the MRI signal intensity of FLA during the early postoperative phase. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who had undergone SCR using an FLA with or without a mesh between March 2013 and August 2021 were retrospectively analyzed. Follow-up MRI was performed at 3 months. A total of 78 patients (24 in the FLA group and 54 in the FLA + Mesh group) with intact grafts were included. Graft remodeling was evaluated by analyzing the signal-to-noise quotient (SNQ) at the humeral, mid-substance, and glenoid sites. Theoretically, lower SNQ ratios indicate higher strength and better healing of the graft. Results: The mean SNQ was 30.603 (range, 11.790-72.710) in the FLA group and 18.367 (range, 4.464-69.500) in the FLA + Mesh group ( P < .001). Furthermore, significant differences were found between the 2 groups at the humeral and mid-substance sites (37.863 [range, 5.092-81.187] vs 15.512 [range, 1.814-80.869], P < .001; and 29.168 [range, 6.103-73.900] vs 16.878 [range, 2.454-92.416], P = .003; respectively). However, there was no difference between the 2 groups at the glenoid site (25.346 [range, 7.565-86.353] vs 20.354 [range, 3.732-88.468], P = .057). Conclusion: At the 3-month follow-up, the FLA + Mesh group showed a lower MRI signal intensity than the FLA group. The healing and remodeling of an FLA may be enhanced when a mesh is used.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

et al. 2023

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“…Patient‐reported outcome measures (PROMs) focus on measuring outcomes after surgical procedures [30]. Statistically significant differences between preoperative and postoperative PROMs were proposed to correlate with patient‐perceived clinical benefit because statistical significance may not necessarily correlate with clinical relevance [9]. Therefore, PROMs may not be applicable to every patient; PASS and MCID may serve as better parameters because they reflect the limit of minimum improvement and threshold for satisfactory outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of age and gender in rates of achieving minimal clinically important difference and patient‐acceptable symptom state 2 years after arthroscopic superior capsular reconstruction

Ben,

Yeom,

Kholinne

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to evaluate patient‐reported outcome measures (PROMs) and the effects of gender and age on achieving clinically significant outcomes in patients undergoing arthroscopic superior capsular reconstruction (ASCR) with a minimum 2‐year follow‐up.MethodsPatients undergoing ASCR for irreparable rotator cuff tear between 2013 and 2020 were reviewed. Preoperative and minimum 2‐year postoperative PROMs were collected, including American Shoulder and Elbow Surgeons (ASES), Constant, single assessment numeric evaluation (SANE), and visual analog scale (VAS) scores. Minimal clinically important difference (MCID) and patient‐acceptable symptomatic state (PASS) were calculated for each functional score and analyzed according to age and gender. The percentages of patients achieving MCID and PASS were recorded.ResultsThe study included 83 patients, with a mean follow‐up of 3.5 ± 1.4 years. Significant improvements were found in ASES, Constant, SANE, and VAS for all groups based on gender and age. Based on receiver‐operating characteristic curves, all scores had acceptable areas under the curve for PASS. Values for PASS and MCID were 81.5 and 10.3 for ASES; 61.5 and 6.2 for Constant; 82.5 and 11.5 for SANE and 1.5 and 1.1 for VAS, respectively. Analysis of achieving MCID and PASS showed no difference between the groups in the majority of outcome measures. However, female patients achieved the SANE thresholds for PASS at significantly higher rates than male patients. Patients ≥65 years old achieved ASES and Constant thresholds for MCID at significantly higher rates than patients ˂65 years old.ConclusionMost patients achieved MCID and PASS at a 2‐year follow‐up. Patients showed comparable rates of MCID and PASS achievement on most outcome tools based on age and gender. Female patients achieved PASS on SANE at significantly higher rates than male patients and older patients achieved MCID on ASES and Constant at higher rates than young patients. Thus, age is a stronger factor for achieving MCID than gender.Level of EvidenceLevel II.

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“…Pain was evaluated using a visual analogue scale (VAS), with 0 being no pain and 10 being the maximum possible pain. The functional outcomes were evaluated using the ASES score, Constant score, and SANE questionnaire [3]. A dynamometer (Mecmesin BFG 200N) was used to measure isometric strength for the calculation of the Constant score.…”

Section: Outcome Measuresmentioning

confidence: 99%

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

Ben,

Zeng,

Kholinne

et al. 2023

Knee surg. sports traumatol. arthrosc.

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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 studyLevel of evidence Level IV.

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Postoperative MRI signal intensity correlates functional outcomes after superior capsular reconstruction

Cited by 5 publications

References 29 publications

Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

Effect of age and gender in rates of achieving minimal clinically important difference and patient‐acceptable symptom state 2 years after arthroscopic superior capsular reconstruction

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

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