Defining "completely better" status through patient-reported outcome measures after arthroscopic rotator cuff repair

A novel clinical interpretation of patient-reported outcomes (PROs) is "completely better" (CB) status, which has not been thoroughly investigated after arthroscopic rotator cuff repair (RCR). The purpose of this study was to identify patient characteristics and PROs associated with achieving CB status after arthroscopic RCR.

Patients who underwent arthroscopic RCR were retrospectively identified from a prospectively enrolled orthopaedic registry. Patients completed surveys at baseline and 2-years postoperatively. PROs included Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and American Shoulder and Elbow Surgeons (ASES) score. To determine CB status, a question asked, "Is the condition for which you underwent surgery completely better now?", with answers "Yes" or "No".

Of 86 patients, 60 (70%) completed their 2-year survey. 47 (78%) responded "Yes" and 13 (22%) responded "No" to the CB question. Preoperatively, patients achieving CB status had significantly better PROMIS PI (p = .005) and ASES (p = .024). Postoperatively, 2-year PROMIS PF (p = .027), PROMIS PI (p = .001), and ASES (p < .001) were better in the CB group. The combination of threshold scores that best determined CB status was 2-year PROMIS PI ≤ 52.2 AND 2-year ASES ≥ 73.3.

CB status is a novel indicator that raises current thresholds of PRO interpretation to a patient-centered maximum. This study found that CB status is associated with PROs at baseline and 2-years postoperatively. 2-year ASES and PROMIS PI thresholds provided the highest Youden index for CB status. The results allow surgeons to contextualize PROs and target values that maximize patient recovery.