Scanaliato John P, Magnuson Justin A, Klahs Kyle J, Childs Benjamin R, Tyler John, Hettrich Carolyn M, Parnes Nata
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Rothman Orthopaedic Institute, Orlando, Florida, USA.
Orthop J Sports Med. 2024 Nov 5;12(11):23259671241284676. doi: 10.1177/23259671241284676. eCollection 2024 Nov.
Patients with large labral tears represent a subset of traumatic shoulder instability cases. Outcomes after arthroscopic stabilization in these patients have been studied less compared with other tears.
To establish minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds for patients after arthroscopic repair of labral tears ≥270°. Patient-reported outcome measures (PROMs) included the Rowe instability score, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain.
Case-control study; Level of evidence, 3.
A total of 52 arthroscopic large labral repairs (52 patients, mean age 28.7 years) performed in male active-duty military patients with a mean follow-up of 79.2 months (range, 24-117 months) met inclusion criteria and were included in the final analysis. All included patients completed the Rowe, ASES, SANE, and VAS pain preoperatively and at final follow-up, and the MCID, PASS, and SCB were calculated for each PROM score. Factors associated with achieving clinically relevant improvement were also calculated.
The MCID, PASS, and SCB, respectively, for each PROM were as follows: 10.4 points, 90, and 35 points for the Rowe; 9.7 points, 80, and 43 points for the ASES; 9.9 points, 87, and 65 points for the SANE; and 1.1 points, 3, and 6 points for VAS pain. More than 90% of patients improved according to the MCID for each PROM, while >75% achieved the PASS threshold for each score. The percentage of patients who improved according to the SCB ranged from 9.6% for the ASES to 75% for the SANE. Maintenance of active-duty status was associated with achieving the MCID for the ASES and SANE, while recurrent instability was associated with lower rates of Rowe MCID achievement and SANE PASS achievement. Higher preoperative scores were also associated with lower rates of achieving clinical improvement.
Thresholds found for the MCID, PASS, and SCB in active-duty patients undergoing surgery for shoulder instability with labral tears ≥270° were similar to those for all-comers with anterior instability. Factors associated with achieving success or lack thereof on PROMs included maintenance of active-duty status and lower preoperative PROM scores.
存在巨大盂唇撕裂的患者是创伤性肩关节不稳病例中的一个亚组。与其他类型的撕裂相比，对这些患者进行关节镜下稳定修复术后的疗效研究较少。
确定盂唇撕裂≥270°的患者在关节镜修复术后的最小临床重要差异（MCID）、患者可接受症状状态（PASS）和显著临床获益（SCB）阈值。患者报告的结局指标（PROMs）包括Rowe不稳评分、美国肩肘外科医师（ASES）评分、单项评估数字评定法（SANE）以及疼痛视觉模拟量表（VAS）。
病例对照研究；证据等级，3级。
对52例男性现役军人患者进行了52例关节镜下巨大盂唇修复术（平均年龄28.7岁），平均随访79.2个月（范围24 - 117个月），符合纳入标准并纳入最终分析。所有纳入患者在术前和最终随访时均完成了Rowe、ASES、SANE和VAS疼痛评分，并计算每个PROM评分的MCID、PASS和SCB。还计算了与实现临床相关改善相关的因素。
每个PROM的MCID、PASS和SCB分别如下：Rowe评分分别为10.4分、90分和35分；ASES评分为9.7分、80分和43分；SANE评分为9.9分、87分和65分；VAS疼痛评分为1.1分、3分和6分。超过90%的患者根据每个PROM的MCID有改善，而>75%的患者达到了每个评分的PASS阈值。根据SCB有改善的患者百分比范围从ASES的9.6%到SANE的75%。维持现役状态与达到ASES和SANE的MCID相关，而复发性不稳与Rowe MCID达成率和SANE PASS达成率较低相关。术前评分较高也与临床改善达成率较低相关。
在接受手术治疗的盂唇撕裂≥270°的现役患者中发现的MCID、PASS和SCB阈值与所有前向不稳患者的阈值相似。与PROMs成功或未成功相关的因素包括维持现役状态和较低的术前PROM评分。
