Ben Hui, Yeom Ji Woong, Guo Jia, Park Ji Yeon, Ryu Seung Min, Koh Kyoung Hwan, Jeon In-Ho
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2025 May 15;13(5):23259671251337103. doi: 10.1177/23259671251337103. eCollection 2025 May.
Surgeons used the minimal clinically important difference (MCID) to interrogate outcomes-using patient-reported outcomes-to determine whether a patient can achieve clinical benefit after orthopaedic surgery. However, it is proposed to be crucial to separate the idea of meeting a clinically established threshold of patient-reported outcome measures (PROMs), which could truly predict patient-reported satisfaction with that outcome.
To investigate the association between achieving MCID and patient-reported satisfaction after arthroscopic superior capsular reconstruction with fascia lata autografts for irreparable massive rotator cuff tears.
Case-control study; Level of evidence, 3.
A total of 62 patients with ≥2-year follow-up and receiving questionnaires were included. PROMs were collected pre- and postoperatively, including pain visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores. MCIDs were determined using the sensitivity- and specificity-based approaches. Patient-reported satisfaction was evaluated with the following question: "Are you satisfied with your superior capsular reconstruction surgery (yes/no)?" The association between achieving MCID and patient-reported satisfaction was evaluated.
All 3 scores had acceptable area under the curve values (>0.7) for MCID. The MCID values were 4.5, 14.5, and 25.0 for the VAS, ASES, and SANE scores, respectively. Patients achieving MCID for PROMs had significantly greater improvement levels in the other clinical outcome scores than their counterparts ( < .05), except for the VAS score that demonstrated no difference between patients achieving and not achieving the MCID for SANE score ( = .07). Achieving MCID for PROMs was associated with a significantly higher proportion of patients feeling satisfied with the outcomes than the group failing to achieve the MCID (all < .05). However, the percentages of patients who failed to achieve MCID for pain VAS, ASES, and SANE scores reported satisfaction with their results at 63.3%, 54.5%, and 59.1%, respectively.
Achieving MCID thresholds on the VAS, ASES, and SANE scores were predictive of patient-reported satisfaction after arthroscopic superior capsular reconstruction 2 years postoperatively. However, half of the patients who failed to achieve MCID were still satisfied, regardless of clinical outcome improvements. Surgeons may need to be careful when consulting patients about expected outcomes, and patients need to set reasonable expectations based on their preoperative condition.
外科医生使用最小临床重要差异（MCID）来通过患者报告的结果审视骨科手术的疗效，以确定患者在骨科手术后是否能获得临床益处。然而，将达到患者报告结果测量（PROMs）的临床既定阈值这一概念区分开来至关重要，该阈值能够真正预测患者对该结果的报告满意度。
探讨自体阔筋膜关节镜下肩袖上囊重建治疗不可修复的巨大肩袖撕裂术后达到MCID与患者报告满意度之间的关联。
病例对照研究；证据等级，3级。
共纳入62例随访时间≥2年且接受问卷调查的患者。术前和术后收集PROMs，包括疼痛视觉模拟量表（VAS）、美国肩肘外科医师学会（ASES）评分和单项评估数值评定（SANE）评分。使用基于敏感性和特异性的方法确定MCID。通过以下问题评估患者报告的满意度：“您对您的肩袖上囊重建手术满意吗（是/否）？”评估达到MCID与患者报告满意度之间的关联。
所有3项评分在用于MCID时的曲线下面积值均可接受（>0.7）。VAS、ASES和SANE评分的MCID值分别为4.5、14.5和25.0。达到PROMs的MCID的患者在其他临床结局评分上的改善水平显著高于未达到的患者（P<0.05），但VAS评分在达到和未达到SANE评分的MCID的患者之间无差异（P = 0.07）。达到PROMs的MCID的患者对结果感到满意的比例显著高于未达到MCID的组（均P<0.05）。然而，在疼痛VAS、ASES和SANE评分未达到MCID的患者中，分别有63.3%、54.5%和59.1%的患者对其结果表示满意。
术后2年，VAS、ASES和SANE评分达到MCID阈值可预测关节镜下肩袖上囊重建术后患者报告的满意度。然而，尽管临床结局有所改善，但仍有一半未达到MCID的患者对结果感到满意。外科医生在向患者咨询预期结果时可能需要谨慎，患者也需要根据其术前状况设定合理的期望。
