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Minimal Clinically Important Difference and Patient Acceptable Symptomatic State after arthroscopic posterior labral
Ignacio Pasqualini1, Benjamin E Jevnikar1, Nicolás Lucero Viviani2
1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Hypothesis And Background:
Posterior glenohumeral instability is an increasingly recognized cause of shoulder dysfunction in young, active individuals. Although arthroscopic posterior labral repair (PLR) produces favorable outcomes, procedure-specific thresholds defining clinically meaningful improvement remain incompletely established, particularly for sport-specific patient-reported outcome measures (PROMs). The purpose of this study is to define Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) thresholds for the Rowe, American Shoulder and Elbow Surgeons (ASES), and Athletic Shoulder Outcome Scoring System (ASOSS) scores after arthroscopic PLR and determine the proportion of patients achieving these benchmarks.
Methods:
Consecutive patients undergoing isolated arthroscopic PLR between 2018 and 2023 with ≥12-month follow-up were retrospectively analyzed. Pre-operative and 1-year PROMs (Rowe, ASES, and ASOSS) were collected. MCID was calculated as one-half standard deviation of score change. PASS was determined using an anchor-based satisfaction question with receiver operating characteristic analysis to identify optimal cutoffs. Area under the curve assessed discriminative ability.
Results:
Seventy patients (mean age, 20.5 ± 4.0 years; 85.7% male) were analyzed. All PROMs improved significantly at 1 year (Rowe: 41.0 ± 11.5 to 81.0 ± 13.2; ASES: 53.2 ± 3.0 to 89.1 ± 7.3; ASOSS: 54.1 ± 12.6 to 84.9 ± 8.6; all P < .001). Satisfaction was reported by 91% and 90% returned to sport at 4.8 ± 1.9 months, with 81% returning at their preinjury level. Recurrent instability occurred in 5.7% and revision in 2.9%. MCID thresholds were 7.1 (Rowe), 4.2 (ASES), and 8.3 (ASOSS); PASS thresholds were 50, 70, and 65, respectively. Achievement rates were high (Rowe 98.6% MCID/100% PASS; ASES 100%/100%; ASOSS 94.3%/100%). Receiver operating characteristic analysis demonstrated acceptable-to-excellent discrimination (Rowe area under the curve 0.79 [95% confidence interval, 0.68-0.90]; ASES 0.85 [0.72-0.99]; ASOSS 0.86 [0.76-0.95]).
Conclusion:
Arthroscopic PLR reliably produces clinically meaningful improvement. Procedure-specific MCID and PASS thresholds for Rowe, ASES, and ASOSS scores were established in a non-military cohort, providing practical benchmarks for outcome interpretation and counseling.