Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair

Kim, Dong-Min; Kim, Tae Hyung; Kholinne, Erica; Park, Jeong Hee; Shin, Myung Jin; Kim, Hyojune; Park, Dongjun; Jeon, In-Ho; Koh, Kyoung Hwan

doi:10.1177/0363546520943862

Cited by 114 publications

(113 citation statements)

References 32 publications

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“…For function, the only statistically significant difference was for the SANE at six months in favour of early rehabilitation (MD:6.54, 95%CI:2.24, 10.84, p=0.003). The mean difference found for outcome measures for function were small and did not reach the minimal clinically important differences (MCID)(36-38). The MCID for the SANE for patients undergoing rotator cuff repair is reported to be 16.9 (37).…”

Section: Discussionmentioning

confidence: 85%

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Mazuquin

Moffatt

Gill

et al. 2021

Preprint

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Objective: To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity. Design: Systematic review and meta-analyses. Methods: We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool. Results: Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24-10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66-12.06), three (MD: 8.45; 95%CI: 3.43-13.47) and six months (MD: 3.57; 95%CI: 0.81-6.32) and one year (MD: 1.42; 95%CI: 0.21-2.64) and similar differences for other planes of movement. In terms of repair integrity at one year, regarding early mobilisation, the number needed to harm was 651. Discussion: Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

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Section: Discussionmentioning

confidence: 85%

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Mazuquin

Moffatt

Gill

et al. 2021

Preprint

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“…Only 50% of our patients had improvements in their ASES scores that reached the minimal clinically important difference of 21.0 points. 25 The greatest improvement was seen in the patient with an intact graft on second look.…”

Section: Discussionmentioning

confidence: 93%

“…Functional outcome was evaluated using the American Shoulder and Elbow Surgeons (ASES) score with minimal clinically important difference as a reference value. 25 For active shoulder ROM, forward flexion (FF) and external rotation (ER) were measured using a handheld goniometer. The internal rotation was measured as the spinous process level that could be reached by the thumb of the patient in a sitting position.…”

Section: Methodsmentioning

confidence: 99%

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

Kholinne

Sun

Kwak

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon–bone allograft has been proposed to improve the failure rate. Purpose: To evaluate the surgical outcomes of SCR using an Achilles tendon–bone allograft for the treatment of IRCTs. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using an Achilles tendon–bone allograft between January 2017 and January 2018. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. The acromiohumeral distance and the status of graft integrity were evaluated using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity at the mean of 7.5 months postoperative. Results: The mean ± SD clinical follow-up period was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and visual analog scale scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively. The acromiohumeral distance improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up. However, second-look arthroscopy at a mean of 7.6 months postoperatively confirmed a graft failure rate of 83.3%. Conclusion: SCR using an Achilles tendon–bone allograft for the treatment of IRCTs had a high graft failure rate among patients in this case series.

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“…For function, the only statistically significant difference was for the SANE at six months in favour of early rehabilitation (MD:6.54, 95%CI:2.24, 10.84, p = 0.003). The mean difference found for outcome measures for function were small and did not reach the minimal clinically important differences (MCID) [ 37 – 39 ]. The MCID for the SANE for patients undergoing rotator cuff repair is reported to be 16.9 [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses

et al. 2021

View full text Add to dashboard Cite

Objective To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity. Design Systematic review and meta-analyses. Methods We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool. Results Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24–10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66–12.06), three (MD: 8.45; 95%CI: 3.43–13.47) and six months (MD: 3.57; 95%CI: 0.81–6.32) and one year (MD: 1.42; 95%CI: 0.21–2.64) and similar differences for other planes of movement. In terms of repair integrity, early mobilisation does not seem to increase the risk of re-tears (OR:1.05; 95%CI: 0.64–1.75). Discussion Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

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Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State After Arthroscopic Rotator Cuff Repair

Cited by 114 publications

References 32 publications

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: Systematic review and meta-analyses

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