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    Determining minimal clinically important difference and patient-acceptable symptom state after arthroscopic isolated subscapularis repair
    (Elsevier B.V., 2024) Kilic, Ali Ihsan; Zuk, Nicholas A.; Ardebol, Javier; Pak, Theresa; Menendez, Mariano E.; Denard, Patrick J.
    Background: Minimal Clinically Important Difference (MCID) and Patient-Acceptable Symptomatic State (PASS) have emerged as patient-based treatment assessments. However, these have not been investigated in patients undergoing arthroscopic isolated subscapularis repair (AISR). The primary purpose of this study was to determine the MCID and PASS for commonly used patient-reported outcomes in individuals who underwent AISR. The secondary purpose was to assess potential associations between preoperative and intraoperative patient characteristics and the MCID and PASS. Methods: A retrospective analysis was conducted on prospectively collected data for patients who underwent primary AISR between 2011 and 2021 at a single institution, with minimum 2-year postoperative follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and Visual Analog Scale (VAS) pain scale. The MCID was determined using the distribution-based method, while PASS was evaluated using area under the curve analysis. To investigate the relationship between preoperative variables and the achievement of MCID and PASS thresholds, Pearson and Spearman coefficient analyses were employed for continuous and noncontinuous variables, respectively. Results: A total of 77 patients with a mean follow-up of 58.1 months were included in the study. The calculated MCID values for VAS pain, ASES, and SSV were 1.2, 10.2, and 13.2, respectively. The PASS values for VAS pain, ASES, and SSV were 2.1, 68.8, and 68, respectively. There was no significant correlation between tear characteristics and the likelihood of achieving a MCID or PASS. Female sex, worker's compensation status, baseline VAS pain score, and baseline ASES score, exhibited weak negative correlations for achieving PASS for VAS pain and ASES. Conclusion: This study defined the MCID and PASS values for commonly used outcome measures at short-term follow-up in patients undergoing AISR. Tear characteristics do not appear to impact the ability to achieve a MCID or PASS after AISR. Female sex, worker's compensation claim, and low baseline functional scores have weak negative correlations with the achievement of PASS for VAS pain and ASES scores. © 2024 The Author(s)
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    Determining the Patient Acceptable Symptom State (PASS) for Shoulder Strength After Subscapularis Arthroscopic Repair and Evaluating the Preoperative Predictors for PASS Achievement
    (Sage Publications Inc, 2024) Gonzalez-Morgado, Diego; Ardebol, Javier; Kilic, Ali Ihsan; Noble, Matthew B.; Galasso, Lisa A.; Menendez, Mariano E.; Denard, Patrick J.
    Background: Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength.Purpose: To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement.Study Design: Case-control study; Level of evidence, 3.Methods: A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths.Results: The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.Conclusion: This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.
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    Patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty
    (Mosby-Elsevier, 2024) Ardebol, Javier; Flores, Adrian; Kilic, Ali Ihsan; Pak, Theresa; Menendez, Mariano E.; Denard, Patrick J.
    Background: The optimal management of primary glenohumeral arthritis (GHOA) in the elderly is an ongoing topic of debate. The purpose of this study was to compare functional outcomes and complications in patients aged 75 years or older treated with anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) for primary GHOA with an intact rotator cuff. Methods: A retrospective study was performed on a prospectively maintained database which was queried for patients 75 years of age or older who underwent TSA or RSA for primary GHOA with an intact rotator cuff at a single institution between 2012 and 2021 with minimum 2 -year follow-up. Patient -reported outcomes (PROs), including Visual Analog Scale for pain, American Shoulder and Elbow Surgeons, and Subjective Shoulder Value, as well as active range of motion including forward flexion, external rotation, internal rotation, were collected preoperatively and postoperatively. Complications, reoperations, and satisfaction were also recorded. The percentage of patients achieving clinically significant improvement was evaluated with the minimally clinical important difference, substantial clinical benefit, and patient acceptable symptomatic state for each PRO. Results: One -hundred and 4 patients were available for analysis, including 67 TSA patients and 37 RSAs with a mean follow-up of 39.4 months. Preoperative baseline characteristics, PROs, and range of motion were similar between groups. RSA was more commonly performed for eccentric glenoid wear (Walch B2/B3, 62% vs. 22%; P < .001). While clinical outcomes improved comparably in both groups, the TSA cohort showed significantly greater improvement in external rotation (36 degrees vs. 26 degrees ; P = .013). Both cohorts had low revision (3% for TSA vs. 0% for RSA) and complication (7% for TSA vs. 5% for RSA; P = .677) rates. Satisfaction was similar in both groups (93% for TSA vs. 92% for RSA; P = .900). Clinically significant improvement was comparable between groups based on the American Shoulder and Elbow Surgeons score (minimally clinical important difference, 93% for TSA vs. 100% for RSA; substantial clinical benefit, 82% vs. 95%; patient acceptable symptomatic state, 67% vs. 78%; P > .05). Conclusion: In this retrospective small sample size comparison study, TSA and RSA provide similar short-term clinical outcomes for patients 75 years and older with primary GHOA and an intact rotator cuff. Complication and revision rates are comparably low at shortterm follow-up. Our data suggests that advanced age alone should not be used as a decision -making tool for TSA vs. RSA in the setting of primary GHOA with an intact rotator cuff. Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
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    The Subscapularis Healing Index: A New Scoring System for Predicting Subscapularis Healing After Arthroscopic Repair
    (Sage Publications Inc, 2024) Kilic, Ali I.; Zuk, Nicholas A.; Ardebol, Javier; Galasso, Lisa A.; Noble, Matthew B.; Menendez, Mariano E.; Denard, Patrick J.
    Background: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking. Purpose: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs). Results: Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex (P = .008; OR, 3.119), body mass index (BMI) >= 30 (P = .053; OR, 2.323), supraspinatus fatty infiltration >= 3 (P = .033; OR, 3.211), lower SSC fatty infiltration >= 2 (P = .037; OR, 3.608), and Lafosse classification >= 3 (P = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI >= 30, 3 points for supraspinatus fatty infiltration >= 3, 4 points for lower SSC fatty infiltration >= 2, and 3 points for Lafosse classification >= 3. Patients with <= 4 points had a 4% healing failure rate, while those with >= 9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: Delta ASES, 44.7; unhealed SSC: Delta ASES, 29; P < .01) and SSV (healed SSC: Delta SSV, 52.9; unhealed SSC: Delta SSV, 27.5; P < .01) and lower VAS (healed SSC: Delta VAS, -4.2; unhealed SSC: Delta VAS, -3; P < .01) scores compared with those with an unhealed SSC. Conclusion: The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.
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    YouTube content on shoulder arthroplasty is highly viewed but is of poor educational quality
    (W.B. Saunders, 2024) Ardebol, Javier; Kiliç, Ali Īhsan; Hwang, Simon; Pak, Theresa; Menendez, Mariano E.; Denard, Patrick J.
    Background: YouTube videos on shoulder arthroplasty cover a broad range of topics, from patient testimonials to surgical techniques. Inherent to this platform, there are no quality control measures to monitor this content. The purpose of this study is to evaluate the quality and popularity of videos on shoulder arthroplasty on YouTube, using both previously described scores and a proposed novel shoulder arthroplasty–specific score assessing educational content. Methods: A search was performed using the keywords “shoulder arthroplasty” and “shoulder replacement” on YouTube. Videos were sorted by relevance and the first 50 videos for each keyword were included in a playlist. The videos in the playlist were then sorted by popularity and the first 50 were included for analysis. Videos in a non-English language, duplicate videos, or those lacking audio were excluded. Video source, content, time since upload, duration, like and dislike count, were inputted for analysis. The view ratio and video power index were used to assess for popularity. Quality, reliability and educational content were evaluated with the Global Quality Score (GQS), Journal of the American Medical Association (JAMA), and the novel Shoulder Arthroplasty Video Content (SAVC) score, respectively. Results: The 50 videos had an average of 285,375 views and a mean duration of 10.8 minutes. Video content was comprised of primarily surgical technique (46%) and patient experience (44%), with most of the videos uploaded from university-affiliated physicians (30%), non-affiliated physicians (28%), and medical (i.e., animations from health websites) (26%) sources. Mean GQS (i.e., quality) and JAMA (i.e., reliability) scores for all videos were 3.2 ± 1.2 out of 5 and 2.4 ± 1.4 out of 4, respectively. Median GQS was comparable across sources, content, and procedure type. Although median JAMA scores were similar among procedure and content type, academic and medical sources showed significantly higher scores among video source categories (P = .04). The mean SAVC score was 19.5 ± 10.7 out of 45 possible points. While there was no significant difference in SAVC scores when categorized by procedure type, a significant difference was observed when assessed by source (P = .02) and content (P = .01). Specifically, medical sources had the highest median score for video source and patient experience for content. Conclusion: Shoulder arthroplasty videos on YouTube reach a considerable audience, but the educational content and reliability are low. Understanding this can help caution patients on the limitations of educational content on YouTube. © 2024 American Shoulder and Elbow Surgeons