Stojanov Thomas, Audigé Laurent, Aghlmandi Soheila, Rosso Claudio, Moroder Philipp, Suter Thomas, Dao Trong Mai Lan, Benninger Emanuel, Moor Beat, Spormann Christophe, Durchholz Holger, Cunningham Gregory, Lädermann Alexandre, Schär Michael, Flury Matthias, Eid Karim, Scheibel Markus, Candrian Christian, Jost Bernhard, Zumstein Matthias A, Wieser Karl, Schwappach David, Hunziker Sabina, Müller Andreas M
Orthopaedic Surgery and Traumatology, University Hospital Basel, Basel, Switzerland.
Surgical Outcome Research Center, University Hospital of Basel, Basel, Switzerland.
PLoS One. 2025 Jan 10;20(1):e0316712. doi: 10.1371/journal.pone.0316712. eCollection 2025.
The ARCR_Pred study was initiated to document and predict the safety and effectiveness of arthroscopic rotator cuff repair (ARCR) in a representative Swiss patient cohort. In the present manuscript, we aimed to describe the overall and baseline characteristics of the study, report on functional outcome data and explore case-mix adjustment and differences between public and private hospitals. Between June 2020 and November 2021, primary ARCR patients were prospectively enrolled in a multicenter cohort across 18 Swiss and one German orthopedic center. Baseline characteristics, including sociodemographic and diagnostic variables, were reported. Clinical scores and patient-reported outcome measures were assessed up to 24-month follow-up. After screening 2350 individuals, 973 patients with ARCR were included. Follow-up rates reached 99%, 95%, 89% and 88% at 6 weeks, 6, 12, and 24 months, respectively. While the proportion of massive tears was higher in the study population (44% vs. 20%, Std. Diff. = 0.56), there were no other major differences in key characteristics between enrolled and non-enrolled patients or in patients lost to follow-up. Functional scores improved over time, with positive changes rates ranging from 83% to 92% at 6-month, reaching 91% to 97% at 12- and 24-month follow-up. In linear mixed models, used to estimate the associations between baseline factors, hospital type and standardized 0-100 scores, marginal effects for time ranged from 20 to 30, 28 to 39 and 34 to 41 points at the 6-, 12- and 24-month follow-up, respectively. Except at the 12-month follow-up, where marginal effects for the interaction terms ranged from -5 to -4 points in the standardized scores, there were no consistent outcome differences between public and private hospitals. Increasing number of years of education was consistently associated with better scores, greater feelings of depression and anxiety, smoking and ASA group III-IV were consistently associated with worse scores. Tear severity showed a consistent negative association solely for the Constant-Score. The ARCR_Pred study shows high potential for generalizability to the population of patients undergoing an ARCR in Switzerland. Further analyses are needed to establish relevant clinimetrics for the Swiss population and to compare outcomes for surgical techniques, surgeon experiences profiles and post-operative management.
ARCR_Pred研究旨在记录并预测在一个具有代表性的瑞士患者队列中关节镜下肩袖修复术（ARCR）的安全性和有效性。在本论文中，我们旨在描述该研究的总体及基线特征，报告功能结局数据，并探讨病例组合调整以及公立医院和私立医院之间的差异。在2020年6月至2021年11月期间，原发性ARCR患者被前瞻性纳入了瑞士18个和德国1个骨科中心的多中心队列。报告了包括社会人口统计学和诊断变量在内的基线特征。在长达24个月的随访中评估了临床评分和患者报告的结局指标。在筛查了2350名个体后，纳入了973例ARCR患者。在6周、6个月、12个月和24个月时的随访率分别达到99%、95%、89%和88%。虽然研究人群中巨大撕裂的比例较高（44%对20%，标准化差异=0.56），但在纳入和未纳入的患者之间或失访患者的关键特征方面没有其他重大差异。功能评分随时间改善，6个月时的正向变化率在83%至92%之间，在12个月和24个月随访时达到91%至97%。在用于估计基线因素、医院类型和标准化0 - 100分之间关联的线性混合模型中，6个月、12个月和24个月随访时时间的边际效应分别为每20至30分、28至39分和34至41分。除了在12个月随访时，交互项的边际效应在标准化评分中为 - 5至 - 4分，公立医院和私立医院之间没有一致的结局差异。受教育年限增加始终与更好的评分相关，抑郁和焦虑情绪加重、吸烟以及ASA III - IV组始终与更差的评分相关。撕裂严重程度仅对Constant评分显示出一致的负相关。ARCR_Pred研究显示出对瑞士接受ARCR的患者人群具有高度的可推广性潜力。需要进一步分析以建立适用于瑞士人群的相关临床测量指标，并比较手术技术、外科医生经验概况和术后管理的结局。
