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

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 studyLevel of evidence Level IV.

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

“…Recently, orthopaedic literature has seen a shift towards identifying postoperative meaningful improvement rather than statistical improvement of function using PASS and MCID [5,14,31]. PASS refers to the degree of symptoms regarding patient pain and function by distinguishing between satisfaction and dissatisfaction with the patient's current condition [9]. MCID is defined as the minimum amount of change needed for a patient to feel 'better' after treatment [22].…”

“…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.…”