These authors assessed the minimal clinically important differences (MCIDs) for arthroscopic rotator cuff repair in 202 patients having arthroscopic rotator cuff repair.
ASES, SST, and VAS pain scores were collected preoperatively and at 1 year postoperatively. The MCID was then calculated via a 4-question anchor–based method.
Age at time of surgery, sex, anteroposterior tear size, worker’s compensation status, and preoperative patient-reported metrics (ASES, SST, VAS) were not significantly associated with MCID values.
The article makes the interesting observation that the MCIDs for cuff repair are greater than those they found for non-operative treatment of cuff tears, suggesting that patients require more improvement in order to achieve a clinically important difference after surgery than after non-operative management. They conclude, "Use of these higher values should be considered when evaluating improvements of individual patients after rotator cuff repair and to determine the comparative effectiveness of various rotator cuff repair techniques"
Comment: These authors ask a very important question, "how much better do the results of a new technique of rotator cuff repair need to be for the the amount of improvement to be meaningful to the patient?" In other words, it is not enough to find a statistically significant difference between single row and double row, we also need to know whether there is a clinically important difference.
We should be asking the analogous question about proposed advances in shoulder arthroplasty (stemless humeral heads, short stemmed humeral components, patient specific instrumentation, etc). It is interesting that for the traditional approaches to anatomic shoulder arthroplasties, the patient assessed outcomes (i.e. ASES or SST) are very close (i.e. within the MCID) to the maximum possible score. Thus, it may be difficult to demonstrate that new implants and technologies will be able to achieve a clinically significant improvement over what has been commonly in use.
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Eighty-nine patients rated their postoperative shoulder improvement as ‘‘good’’ and thus represented the changed group, whereas 10 and 3 patients rated their improvement postoperatively as ‘‘poor’’ and ‘‘no improvement,’’ respectively, representing the unchanged group (Table I). The remaining 100 patients rated their improvement as ‘‘excellent.’’
The MCID results for the ASES, SST, and VAS pain scores were 27.1, 4.3, and 2.4, respectively.
The MCID results for the ASES, SST, and VAS pain scores were 27.1, 4.3, and 2.4, respectively.
Age at time of surgery, sex, anteroposterior tear size, worker’s compensation status, and preoperative patient-reported metrics (ASES, SST, VAS) were not significantly associated with MCID values.
Comment: These authors ask a very important question, "how much better do the results of a new technique of rotator cuff repair need to be for the the amount of improvement to be meaningful to the patient?" In other words, it is not enough to find a statistically significant difference between single row and double row, we also need to know whether there is a clinically important difference.
We should be asking the analogous question about proposed advances in shoulder arthroplasty (stemless humeral heads, short stemmed humeral components, patient specific instrumentation, etc). It is interesting that for the traditional approaches to anatomic shoulder arthroplasties, the patient assessed outcomes (i.e. ASES or SST) are very close (i.e. within the MCID) to the maximum possible score. Thus, it may be difficult to demonstrate that new implants and technologies will be able to achieve a clinically significant improvement over what has been commonly in use.
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