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Establishing Clinically Significant Improvement for Patients After Arthroscopic Surgery for Shoulder Instability With
John P Scanaliato1, Justin A Magnuson2, Kyle J Klahs3
1Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Orthopaedic Journal of Sports Medicine
|November 7, 2024
Summary
This study establishes clinical outcome thresholds for arthroscopic repair of large labral tears in active-duty military patients. Most patients achieved minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) after surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Shoulder Instability Research
Background:
- Large labral tears are a specific type of traumatic shoulder instability.
- Outcomes for arthroscopic stabilization of large labral tears are less understood than for smaller tears.
Purpose of the Study:
- To determine the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair of labral tears measuring ≥270°.
- To analyze patient-reported outcome measures (PROMs) including the Rowe instability score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain.
Main Methods:
- A case-control study (Level of evidence, 3) analyzed 52 arthroscopic large labral repairs in male active-duty military patients.
- Mean follow-up was 79.2 months, with all patients completing Rowe, ASES, SANE, and VAS pain scores preoperatively and postoperatively.
- MCID, PASS, and SCB thresholds were calculated for each PROM, and factors associated with clinical improvement were assessed.
Main Results:
- Established MCID, PASS, and SCB thresholds for Rowe, ASES, SANE, and VAS pain scores.
- Over 90% of patients met MCID, and over 75% met PASS for all PROMs.
- Substantial clinical benefit (SCB) achievement varied by PROM, ranging from 9.6% (ASES) to 75% (SANE).
- Active-duty status correlated with achieving MCID for ASES and SANE; recurrent instability was linked to lower Rowe MCID and SANE PASS achievement.
- Higher preoperative scores were associated with lower rates of achieving clinical improvement.
Conclusions:
- The established MCID, PASS, and SCB thresholds for active-duty patients with large labral tears are comparable to those for general anterior instability cases.
- Factors influencing successful outcomes included maintaining active-duty status and having lower preoperative PROM scores.
