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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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    Öğe
    The subscapularis healing index: A new scoring system for predicting subscapularis healing after arthroscopic repair
    (Sage Publications Inc, 2024) Kılıç, Ali İhsan; 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.