PMID- 33079576 OWN - NLM STAT- MEDLINE DCOM- 20210114 LR - 20210114 IS - 1552-3365 (Electronic) IS - 0363-5465 (Linking) VI - 48 IP - 14 DP - 2020 Dec TI - Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair. PG - 3447-3453 LID - 10.1177/0363546520962512 [doi] AB - BACKGROUND: Recent literature has focused on correlating statistically significant changes in outcome measures with clinically significant outcomes (CSOs). CSO benchmarks are being established for arthroscopic rotator cuff repair (RCR), but more remains to be defined about them. PURPOSE: To define the time-dependent nature of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptomatic State (PASS) after RCR and to define what factors affect this time to CSO achievement. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: An institutional registry was queried for patients who underwent arthroscopic RCR between 2014 and 2016 and completed preoperative, 6-month, 1-year, and 2-year patient-reported outcome measures (PROMs). Threshold values for MCID, SCB, and PASS were obtained from previous literature for the American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), and subjective Constant score. The time in which patients achieved MCID, SCB, and PASS was calculated using Kaplan-Meier analysis. A Cox multivariate regression model was used to identify variables correlated with earlier or later achievement of CSOs. RESULTS: A total of 203 patients with an average age of 56.19 +/- 9.96 years and average body mass index was 30.29 +/- 6.49 were included. The time of mean achievement of MCID, SCB, and PASS for ASES was 5.77 +/- 1.79 months, 6.22 +/- 2.85 months, and 7.23 +/- 3.81 months, respectively. The time of mean achievement of MCID, SCB, and PASS for SANE was 6.25 +/- 2.42 months, 7.05 +/- 4.10 months, and 9.26 +/- 5.89 months, respectively. The time of mean achievement of MCID, SCB, and PASS for Constant was 6.94 +/- 3.85 months, 7.13 +/- 4.13 months, and 8.66 +/- 5.46 months, respectively. Patients with dominant-sided surgery (hazard ratio [HR], 1.363; 95% CI, 1.065-1.745; P = .014) achieved CSOs earlier on ASES, while patients with workers' compensation status (HR, 0.752; 95% CI, 0.592-0.955; P = .019), who were current smokers (HR, 0.323; 95% CI, 0.119-0.882; P = .028), and with concomitant biceps tenodesis (HR, 0.763; 95% CI, 0.607-0.959; P = .021) achieved CSOs on ASES at later timepoints. Patients with distal clavicle excision (HR, 1.484; 95% CI, 1.028-2.143; P = .035) achieved CSOs earlier on SANE. Patients with distal clavicle excision (HR, 1.689; 95% CI, 1.183-2.411, P = .004) achieved CSOs earlier on Constant, while patients with workers' compensation insurance status (HR, 0.671; 95% CI, 0.506-0.891; P = .006) and partial-thickness tears (HR, 0.410; 95% CI, 0.250-0.671; P < .001) achieved CSOs later on Constant. Greater preoperative score was associated with delayed achievement of CSOs for ASES, SANE (HR, 0.993; 95% CI, 0.987-0.999; P = .020), and Constant (HR, 0.941; 95% CI, 0.928-0.962; P < .001). CONCLUSION: A majority of patients achieved MCID by 6 months after surgery. Dominant-sided surgery and concomitant distal clavicle excision resulted in faster CSO achievement, while workers' compensation status, concomitant biceps tenodesis, current smoking, partial-thickness rotator cuff tears, and higher preoperative PROMs resulted in delayed CSO achievement. FAU - Manderle, Brandon J AU - Manderle BJ AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Gowd, Anirudh K AU - Gowd AK AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Liu, Joseph N AU - Liu JN AD - Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. FAU - Beletsky, Alexander AU - Beletsky A AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Nwachukwu, Benedict U AU - Nwachukwu BU AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Nicholson, Gregory P AU - Nicholson GP AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Bush-Joseph, Charles AU - Bush-Joseph C AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Romeo, Anthony A AU - Romeo AA AD - Division of Shoulder, Elbow, Sports Medicine, Rothman Orthopaedic Institute, New York, New York, USA. FAU - Forsythe, Brian AU - Forsythe B AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Cole, Brian J AU - Cole BJ AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. FAU - Verma, Nikhil N AU - Verma NN AD - Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA. LA - eng PT - Journal Article DEP - 20201020 PL - United States TA - Am J Sports Med JT - The American journal of sports medicine JID - 7609541 SB - IM MH - Aged MH - *Arthroscopy MH - Humans MH - Middle Aged MH - *Minimal Clinically Important Difference MH - *Rotator Cuff/surgery MH - *Rotator Cuff Injuries/surgery MH - Time Factors MH - Treatment Outcome OTO - NOTNLM OT - Patient Acceptable Symptomatic State OT - arthroscopic rotator cuff repair OT - minimal clinically important difference OT - shoulder OT - substantial clinical benefit OT - time to achieve clinical significance EDAT- 2020/10/21 06:00 MHDA- 2021/01/15 06:00 CRDT- 2020/10/20 17:08 PHST- 2020/10/21 06:00 [pubmed] PHST- 2021/01/15 06:00 [medline] PHST- 2020/10/20 17:08 [entrez] AID - 10.1177/0363546520962512 [doi] PST - ppublish SO - Am J Sports Med. 2020 Dec;48(14):3447-3453. doi: 10.1177/0363546520962512. Epub 2020 Oct 20.