Patient Acceptable Symptom State, Minimal Clinically Important Difference, and Substantial Clinical Benefit After Arthroscopic Superior Capsular Reconstruction

Abstract

Background: Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) have rarely been assessed after arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft. Purpose: (1) To investigate PASS, MCID, and SCB values for pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Single Assessment Numeric Evaluation (SANE) after ASCR with fascia lata autograft, (2) to investigate factors for achieving PASS, MCID, and SCB. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: We retrospectively collected data from patients who underwent ASCR between June 2013 and October 2020. A total of 88 patients were included, and anchor questions for deriving PASS, MCID, and SCB values were applied at a minimum 1-year follow-up postoperatively. PASS, MCID, and SCB were derived using sensitivity- and specificity-based approaches. Univariable and multivariable logistic regression analyses were performed to determine factors for achieving PASS, MCID, and SCB. Results: Based on receiver operating characteristic curves, all 4 scores had acceptable area under the curve values (>0.7) for PASS, MCID, and SCB values. The PASS, MCID, and SCB values were 1.5, 2.5, and 4.5 for pVAS; 81.0, 19.0, and 27.5 for the ASES score; 60.5, −0.5, and 5.5 for the Constant score; and 75.0, 27.5, and 32.5 for SANE, respectively. Poor preoperative scores were related to significantly higher odds ratios (ORs) for achieving MCID and SCB. Wide acromiohumeral distance and dominant side were related to higher ORs for achieving PASS for the ASES score, and subscapularis tear was related to lower ORs for achieving PASS for pVAS and SCB for the Constant score. Conclusion: Reliable PASS, MCID, and SCB values were achieved for at least 1 year after ASCR surgery. Poor preoperative score, wide acromiohumeral distance, and dominant side all demonstrated higher ORs for at least one value, but a subscapularis tear demonstrated lower ORs for achieving PASS for pVAS and SCB for the Constant score.

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

“…The current cohort revealed that a higher preoperative VAS score favoured earlier MCID achievement but higher preoperative ASES and SANE scores contributed to delayed MCID achievement, demonstrating the previously reported important roles of preoperative functional conditions in MCID achievement [8,28]. Yeom et al found lower preoperative scores to generate significantly higher odds ratios in the postoperative MCID and substantial clinical benefit, suggesting a higher possibility of achieving MCID and substantial clinical benefit after arthroscopic superior capsular reconstruction [28]. Similarly, Evuarherhe et al found a lower preoperative ASES score to be predictive of the achievement of MCID and substantial clinical benefit [8].…”

“…A shoulder MRI was performed with a 3T machine (Achieva; Philips Healthcare) before SCR. On MRI, the Goutallier classification was used to assess fatty infiltration of the RC muscles [20], and the Patte classification was used to assess RC retraction [28]. All imaging evaluation was performed by a fellowship‐trained shoulder surgeon (H.B.)…”

“…Recently, Manderle et al investigated the timeline of the achievement of clinically significant outcomes and their contributing factors after arthroscopic rotator cuff repair [22]. Although MCID, substantial clinical benefit, and PASS values for PROMs after ASCR have been previously investigated [8,28], knowledge about the time-dependent nature of clinically significant outcomes after arthroscopic superior capsular reconstruction is lacking. Therefore, the purposes of this study were (1) to investigate the time required to achieve MCID, substantial clinical benefit, and PASS after arthroscopic superior capsular reconstruction for four shoulder PROMs: the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), visual analogue scale (VAS), and Constant scores; and (2) to identify factors associated with the time required for the achievement.…”

“…Currently used clinically significant outcome (CSO) measures consist of the minimal clinically important difference (MCID), substantial clinical benefit, and Patient Acceptable Symptomatic State (PASS) [22, 28]. MCID is defined as the minimum degree of quantifiable outcome improvement that a patient perceives after treatment.…”

Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score–Matched Study

“…Most of the variables have been shown to have an effect on the surgical results of aRCR and aSCR. 21,24,46,48,51,54…”