Department of Orthopaedics and Sports Medicine, Mayo Clinic, Rochester, MN, USA.
Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2021 Feb;30(2):430-438. doi: 10.1016/j.jse.2020.05.038. Epub 2020 Jun 25.
Patient postoperative pain is an important consideration following biceps tenodesis. The visual analog scale (VAS) for pain is one of the most commonly used measures for perioperative pain assessment. Currently, there is limited understanding of clinically significant improvement in VAS pain.
To define the substantial clinical benefit (SCB), patient acceptable symptomatic state (PASS), and minimal clinically important difference (MCID) for the VAS pain score in patients undergoing open subpectoral (OSPBT) or arthroscopic suprapectoral biceps tenodesis (ASPBT) at 1 year from surgery; and to identify preoperative predictors of achieving each outcome end point.
Data from consecutive patients who underwent isolated biceps tenodesis between January 2014 and March 2017 were collected and analyzed. Baseline data and postoperative patient-reported outcome (PRO) scores were recorded at 1 year postoperatively. In order to quantify the clinical significance of outcome achievement for the VAS pain score, the MCID, PASS, and SCB were calculated.
A total of 165 patients were included in the final analysis. The VAS pain score threshold for achieving MCID was defined as a decrease of 12.9 (0-100). PASS was defined as achieving a 2-year postoperative score of 27.4 points (0-100), and SCB was defined as a decrease of 25.1 (0-100) at 1-year follow-up. The rates of achieving MCID, PASS, and SCB were 73.3%, 52.8%, and 45.9%, respectively. Multivariate regression analysis demonstrated that ASPBT (P = .01) and a lower preoperative Constant-Murley score were predictive of achieving the MCID (P = .01). In contrast, a lower preoperative score on the SF-12 Physical Component Summary (P = .01) and a higher score on the preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P < .001) were predictive of achieving the SCB and PASS, respectively. Preoperative duration of symptoms >6 months was predictive of a reduced likelihood to achieve PASS.
This study identified scores for VAS pain that can be used to define clinically significant outcome after biceps tenodesis. Specifically, a decrease in pain score of 12.9 was a clinically important improvement in VAS pain, whereas a decrease of 25.1 represented the upper threshold of VAS pain improvement. Additionally, there were both modifiable and nonmodifiable factors that predicted achieving clinically significant levels of postoperative pain improvement.
患者术后疼痛是肱二头肌肌腱固定术后需要考虑的一个重要问题。疼痛视觉模拟评分（VAS）是围手术期疼痛评估中最常用的方法之一。目前，对于 VAS 疼痛评分的临床显著改善程度的理解有限。
定义术后 1 年接受开放式（OSPBT）或关节镜下（ASPBT）肱二头肌肌腱固定术患者 VAS 疼痛评分的显著临床获益（SCB）、患者可接受的症状状态（PASS）和最小临床重要差异（MCID），并确定每个结局终点的术前预测指标。
收集了 2014 年 1 月至 2017 年 3 月期间连续接受单纯肱二头肌肌腱固定术的患者的数据并进行了分析。记录了患者术后 1 年的基线数据和术后患者报告的结局（PRO）评分。为了量化 VAS 疼痛评分结局的临床意义，计算了 MCID、PASS 和 SCB。
最终分析共纳入 165 例患者。VAS 疼痛评分 MCID 的阈值定义为下降 12.9（0-100）。PASS 定义为术后 2 年评分达到 27.4 分（0-100），SCB 定义为术后 1 年随访时下降 25.1（0-100）。达到 MCID、PASS 和 SCB 的比例分别为 73.3%、52.8%和 45.9%。多变量回归分析表明，ASPBT（P=.01）和较低的术前Constant-Murley 评分是达到 MCID 的预测因素（P=.01）。相反，术前 SF-12 生理成分综合评分较低（P=.01）和术前美国肩肘外科医生标准肩部评估表评分较高（P<.001）分别是达到 SCB 和 PASS 的预测因素。术前症状持续时间>6 个月与 PASS 降低的可能性相关。
本研究确定了 VAS 疼痛评分，可以用于定义肱二头肌肌腱固定术后的临床显著结局。具体来说，疼痛评分下降 12.9 是 VAS 疼痛的显著改善，而疼痛评分下降 25.1 则代表 VAS 疼痛改善的上限阈值。此外，有一些可改变和不可改变的因素可以预测术后疼痛改善达到临床显著水平。
