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Stolwijk PJ, Verweij LPE, Kerkhoffs GMMJ, van Deurzen DFP, Priester-Vink S, Sierevelt IN, van den Bekerom MPJ. Patient-Reported Outcome Measures Show No Relevant Change Between 1-year and 2-year Follow-Up Following Treatment for Anterior Shoulder Instability: a Systematic Review. Arthroscopy 2024:S0749-8063(24)00635-2. [PMID: 39243995 DOI: 10.1016/j.arthro.2024.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/09/2024]
Abstract
PURPOSE The primary aim of this study was to compare patient-reported outcome measures (PROMs) at 1-year and 2-year follow-up following treatment for anterior shoulder instability. METHODS Randomized controlled trials and prospective studies that evaluated and reported PROMs following a capsulolabral repair (with or without remplissage), bone augmentation or non-operative treatment to treat anterior shoulder instability at both 1-year and 2-year follow-up were included. PROMs were compared between 1-year and 2-year follow-up, forest plots with mean difference were created to compare baseline, 1-year and 2-year follow-up and scatterplots were created to visualize clinical improvement over time. RESULTS Fourteen studies, comprising 923 patients, with level of evidence I and II were included. Nine PROMs, of which predominantly the Western Ontario Shoulder Instability Index (WOSI; 11 studies; 79%), were evaluated. Minimal to no statistically significant change in WOSI, Oxford Shoulder Instability Score (OSIS), American Shoulder and Elbow Surgeons (ASES), Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Disabilities of Arm, Shoulder, and Hand (DASH), Quick DASH, Single Assessment Numeric Evaluation (SANE) or Visual Analogue Scale (VAS) was observed between 1-year and 2-year follow-up. Pooling of the WOSI, OSIS, ASES and SANE demonstrated improvement from baseline to 1-year follow-up and minimal to no change between 1-year and 2-year follow-up. Scatterplots of the WOSI and ASES demonstrated the most improvement within 6 months and no clear improvement after 1-year follow-up. Recurrence rates increased with time but varied between studies. CONCLUSION In contrast to recurrence rates which have been shown to increase with time, minimal to no statistically significant change was observed for any of the included PROMs between 1-year and 2-year follow-up. This finding questions whether it is necessary to evaluate PROMs in long term follow-up of patients following shoulder stabilization treatment. LEVEL OF EVIDENCE Level II, systematic review of Level I - II studies.
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Affiliation(s)
- Paul J Stolwijk
- Amsterdam UMC, location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands.
| | - Lukas P E Verweij
- Amsterdam UMC, location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Amsterdam UMC, location AMC, University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, The Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, The Netherlands
| | | | - Inger N Sierevelt
- Xpert Clinics, Department of Orthopedic Surgery, Amsterdam, The Netherlands; Spaarnegasthuis Academy, Orthopedic Department, Hoofddorp, The Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, The Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow unit, OLVG, Amsterdam, The Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Pasqualini I, Rossi LA, Pan X, Denard PJ, Scanaliato JP, Levin JM, Dickens JF, Klifto CS, Hurley ET. High Variability in Standardized Outcome Thresholds of Clinically Important Changes in Shoulder Instability Surgery: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00576-0. [PMID: 39173689 DOI: 10.1016/j.arthro.2024.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE The purpose of this study was to examine reported MCID and PASS values for PROMs following shoulder instability surgery and assess variability in published values depending on the surgery performed. Secondarily, our aims were to describe the methods used to derive MCID and PASS values in the published literature, including anchor-based, distribution-based, or other approaches, and to assess the frequency of MCID and PASS usage in studies on shoulder instability surgery. METHODS A systematic review of MCID and PASS values following Bankart, Latarjet, and Remplissage procedures was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The Embase, Pubmed, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were queried from 1985 to 2023. Inclusion criteria included studies written in English, and studies reporting utilization MCID or PASS for patient reported outcome measures (PROMS) following Latarjet, Bankart, Remplissage approaches for shoulder instability surgery. Extracted data included study population characteristics, intervention characteristics, and outcomes of interest. Continuous data were described using median and range. Categorical variables, including PROMs reported and MCID/PASS methods, were described using percentages. As MCID is a patient-level metric and not a group-level metric, the authors validated that all included studies reported proportions (%) of subjects that met or exceeded the MCID. RESULTS A total of 174 records were screened, and 8 studies were included in this review. MCID was the most widely utilized outcome threshold which was reported in all 8 studies, with only 2 studies reporting both the MCID and the PASS. The most widely studied PROMs were the American Shoulder and Elbow Surgeons (ASES) (range 5.65-9.6 for distribution MCID, 8.5 anchor MCID, 86 anchor PASS); Single Assessment Numeric Evaluation (SANE) (range 11.4-12.4 distribution MCID, 82.5-87.5 anchor PASS); visual analog scale (VAS) (range 1.1-1.7 distribution MCID, 1.5-2.5 PASS); Western Ontario Shoulder Instability Index (WOSI) (range 60.7-254.9 distribution MCID, 126.43 anchor MCID, 571-619.5 anchor PASS); and Rowe scores (range 5.6-8.4 distribution MCID, 9.7 anchor MCID). Notably, no studies reported on substantial clinical benefit (SCB) or maximal outcome improvement (MOI). CONCLUSION Despite the wide array of available PROMs for assessing shoulder instability surgery outcomes, the availability of clinically significant outcome thresholds such as MCID and PASS remains relatively limited. While MCID has been the most frequently reported metric, there is considerable inter-study variability observed in their values. CLINICAL RELEVANCE Knowing the outcome thresholds such as MCID and PASS of the PROMs frequently used to evaluate the results of glenohumeral stabilization surgery is fundamental, since they allow us to know what is a clinically significant improvement for the patient.
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Affiliation(s)
| | | | - Xuankang Pan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
| | | | - John P Scanaliato
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
| | - Jay M Levin
- Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, NC, USA.
| | - Jonathan F Dickens
- Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, NC, USA.
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, NC, USA.
| | - Eoghan T Hurley
- Oregon Shoulder Institute, Medford, OR, USA; Department of Orthopedic Surgery, Division of Hand and Upper Extremity, Duke University, Durham, NC, USA.
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Rossi MJ, Brand JC, Lubowitz JH. Arthroscopy Journal: Reflections on 2023 and Auld Lang Syne. Arthroscopy 2023; 39:2399-2402. [PMID: 37981382 DOI: 10.1016/j.arthro.2023.08.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 11/21/2023]
Abstract
Auld lang syne; times long past. We were unsuspecting of the coming pandemic. Things changed. COVID-19 impacted each of us, our families, our patients, our medical practices, and our daily lives. The year 2020 was one of cancellation and loss; 2021 and 2022 were years of adaptation, caution, and continued loss. Finally, 2023 began a time of recovery; while COVID-19 is still with us, the pandemic has been declared ended, and we emerge with gratitude. We slowly removed our masks and rediscovered the vitality of meeting face-to-face. And throughout, Arthroscopy has continued to develop, including new journals; special issues on rehabilitation, biologics, and diversity as they relate to musculoskeletal care; collaboration with the American Board of Orthopaedic Surgery, Maintenance of Certification, Web-Based Longitudinal Assessment Pathway; Arthroscopy Techniques; Infographics; Visual Abstracts; and Podcasts. At year end, we extend special thanks to editors whose terms have expired, our team and leaders, our reviewers, our authors and readers, and our patients who offer us their trust and an opportunity to serve.
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Brand JC, Rossi MJ, Lubowitz JH. Arthroscopy Honors Award-Winning Articles and Authors: Our Annual Research Awards. Arthroscopy 2023; 39:1-6. [PMID: 36543414 DOI: 10.1016/j.arthro.2022.10.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/23/2022]
Abstract
With genuine gratitude to the AANA Education Foundation for their unstinting support, it is our honor to announce Arthroscopy's Annual Awards for the best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2022, as well as the Most Downloaded and Most Cited papers published 5 years ago. And as is customary in January, our editors update their disclosures of potential conflicts of interest, as we require of authors, and we update our masthead to introduce new members of our Editorial Board and Social Media Board.
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Woodmass JM, Wagner ER, Smith J, Welp KM, Chang MJ, Morissette MP, Higgins LD, Warner JJP. Postoperative recovery comparisons of arthroscopic Bankart to open Latarjet for the treatment of anterior glenohumeral instability. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1357-1364. [PMID: 35665856 DOI: 10.1007/s00590-022-03265-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recurrent anterior glenohumeral instability is a disabling pathology that can be successfully treated by arthroscopic Bankart repair or open Latarjet. However, there is a paucity of studies comparing the postoperative recovery. The purpose of this study is to evaluate the postoperative pain and functional recovery following arthroscopic Bankart versus open Latarjet. METHODS This is a retrospective analysis of a multicenter prospective outcomes registry database. Postoperative recovery outcomes of either a primary or revision arthroscopic Bankart and open Latarjet procedures were compared. A minimum of 1-year follow-up was required. Outcomes measures included pain visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) function score, ASES index score, and single assessment numeric evaluation (SANE) score. Overall, 787 patients underwent primary arthroscopic Bankart, 36 underwent revision arthroscopic Bankart and 75 underwent an open Latarjet procedure. RESULTS When compared to primary arthroscopic Bankart, open Latarjet demonstrated significantly lower VAS scores at 6 weeks (p = 0.03), 3 months (p = 0.01), and 2 years (p < 0.05). Medium-term outcomes for ASES scores and SANE score, at 1 and 2 years showed no difference. Latarjet demonstrated significantly lower (p < 0.05) preoperative early postoperative VAS pain scores with no difference at 1 year or 2 years when compared to primary Bankart. There was no difference in ASES function or index between Bankart and Latarjet. Revision Bankart provided inferior outcomes for VAS, ASES function, and ASES index when compared to primary Bankart and Latarjet at 1 year and 2 years. CONCLUSIONS Primary arthroscopic Bankart repair and open Latarjet provided nearly equivalent improvements in pain (VAS) and functional outcomes (ASES, SANE, VR-12) during the early recovery phase (2 years). This study supports the use of either procedure in the primary treatment of anterior glenohumeral instability. Revision arthroscopic Bankart repair demonstrated deteriorating outcomes at 1 and 2 years postoperatively.
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Affiliation(s)
- Jarret M Woodmass
- Boston Shoulder Institute, Boston, MA, USA.,Pan Am Clinic, University of Manitoba, Winnipeg, MB, Canada
| | - Eric R Wagner
- Boston Shoulder Institute, Boston, MA, USA.,Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Kathryn M Welp
- Boston Shoulder Institute, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Michelle J Chang
- Boston Shoulder Institute, Boston, MA, USA.,Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
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Differences in Patients' and Surgeons' Expectations before Shoulder Stabilization Surgery. J Clin Med 2021; 10:jcm10204661. [PMID: 34682779 PMCID: PMC8538762 DOI: 10.3390/jcm10204661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 01/03/2023] Open
Abstract
Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.
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Wu IT, Desai VS, Mangold DR, Camp CL, Barlow JD, Sanchez-Sotelo J, Dahm DL, Krych AJ. Comparable clinical outcomes using knotless and knot-tying anchors for arthroscopic capsulolabral repair in recurrent anterior glenohumeral instability at mean 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:2077-2084. [PMID: 32462270 DOI: 10.1007/s00167-020-06057-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/10/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare rates of recurrent instability, revision surgery and functional outcomes following arthroscopic anterior capsulolabral repair for recurrent anterior instability using knot-tying versus knotless suture anchor techniques. METHODS Patients who had undergone arthroscopic anterior labrum and capsular repair for recurrent anterior glenohumeral instability using knotless anchors were identified. Those with minimum 2-year follow-up were matched (1:2) to knot-tying anchor repair patients. Rates of failure and recurrent instability were compared, as well as Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), University of California Los Angeles (UCLA) and Rowe scores. RESULTS One hundred and two patients (89 males, 13 females) with a mean age of 24.3 ± 9.6 were included. Repair was performed with knotless anchors in 34 and knot-tying anchors in 68 shoulders. At mean follow-up of 4.8 ± 2.5 years, re-dislocation rates between groups were not significantly different (knotless anchor: 9% versus knot-tying group: 15%, n.s.), but the knot-tying group showed a higher re-subluxation rate (p = 0.039). 12 (18%) revisions were performed in the knot-tying group at a mean 2.9 years after surgery and 1 (3%) revision in the knotless anchors group at 1.4 years (n.s.). There was no difference in mean VAS with use (1.3 ± 1.9 versus 0.8 ± 1.5, n.s.), SANE scores (91.8 ± 12.7 versus 92.0 ± 11.0, n.s.), QuickDASH scores (4.1 ± 5.5 versus 3.0 ± 6.5, n.s.), UCLA Shoulder Score (32.5 ± 3.6 versus 33.2 ± 3.1, n.s.), or Rowe scores (90.5 ± 18.5 versus 92.2 ± 16.6, n.s.) between knotless and knot-tying groups, respectively. VAS at rest was higher in the knotless group (0.7 ± 1.5 vs 0.1 ± 0.4, p = 0.021). CONCLUSIONS Knotless anchors demonstrated similar rates of re-dislocation and revision surgery, and lower rates of recurrent subluxation, compared to knot-tying anchors. Patients achieved good-to-excellent functional outcomes. This supports the efficacy of knotless anchors as an alternative to knot-tying anchors for arthroscopic anterior labral repair of recurrent anterior shoulder dislocation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Isabella T Wu
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Vishal S Desai
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Devin R Mangold
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Jonathan D Barlow
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
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[Quality in shoulder surgery: is return to play all that matters?]. Chirurg 2021; 92:904-906. [PMID: 34097077 DOI: 10.1007/s00104-021-01431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Pathologies of the shoulder joint present a significant burden on not only the affected individual but also the healthcare system as a whole. This article serves to delineate the outcomes that patients expect from undergoing shoulder surgery and the results that occur following shoulder surgery.
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Bayomy AF, Schickendantz MS, Briskin IN, Farrow LD, Grobaty LE, Jones MH, McCoy BW, Miniaci A, Ricchetti ET, Rosneck JT, Sosic E, Spindler KP, Stearns KL, Strnad GJ, Williams J, Saluan PM. What Are the Predictors of Poor Patient-Reported Outcomes After Shoulder Instability Surgery? Orthop J Sports Med 2020; 8:2325967120966343. [PMID: 33447618 PMCID: PMC7780330 DOI: 10.1177/2325967120966343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Prospectively collected responses to Patient Acceptable Symptom State (PASS) questions after shoulder instability surgery are limited. Responses to these outcome measures are imperative to understanding their clinical utility. Purpose/Hypothesis: The purpose of this study was to evaluate which factors predict unfavorable patient-reported outcomes after shoulder instability surgery, including “no” to the PASS question. We hypothesized that poor outcomes would be associated with male adolescents, bone loss, combined labral tears, and articular cartilage injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥13 years undergoing shoulder instability surgery were included in point-of-care data collection at a single institution across 12 surgeons between 2015 and 2017. Patients with anterior-inferior labral tears were included, and those with previous ipsilateral shoulder surgery were excluded. Demographics, American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, and surgical findings were obtained at baseline. ASES and SANE scores, PASS responses, and early revision surgery rates were obtained at a minimum of 1 year after the surgical intervention. Regression analyses were performed. Results: A total of 234 patients met inclusion criteria, of which 176 completed follow-up responses (75.2%). Nonresponders had a younger age, greater frequency of glenoid bone loss, fewer combined tears, and more articular cartilage injuries (P < .05). Responders’ mean age was 25.1 years, and 22.2% were female. Early revision surgery occurred in 3.4% of these patients, and 76.1% responded yes to the PASS question. A yes response correlated with a mean 25-point improvement in the ASES score and a 40-point improvement in the SANE score. On multivariate analysis, combined labral tears (anterior-inferior plus superior or posterior tears) were associated with greater odds of responding no to the PASS question, while both combined tears and injured capsules were associated with lower ASES and SANE scores (P < .05). Sex, bone loss, and grade 3 to 4 articular cartilage injuries were not associated with variations on any patient-reported outcome measure. Conclusion: Patients largely approved of their symptom state at ≥1 year after shoulder instability surgery. A response of yes to the PASS question was given by 76.1% of patients and was correlated with clinically and statistically significant improvements in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across patient-reported outcome measures, whereas sex, bone loss, and cartilage injuries were not.
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Affiliation(s)
| | - Ahmad F Bayomy
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Isaac N Briskin
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Lutul D Farrow
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren E Grobaty
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Morgan H Jones
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Brett W McCoy
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Anthony Miniaci
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric T Ricchetti
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - James T Rosneck
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Elizabeth Sosic
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Kim L Stearns
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Greg J Strnad
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - James Williams
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul M Saluan
- Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA
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10
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Patel BH, Lu Y, Agarwalla A, Puzzitiello RN, Nwachukwu BU, Cvetanovich GL, Chahla J, Forsythe B. Maximal Medical Improvement Following Shoulder Stabilization Surgery May Require up to 1 Year: A Systematic Review. HSS J 2020; 16:534-543. [PMID: 33380993 PMCID: PMC7749924 DOI: 10.1007/s11420-020-09773-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increased emphasis on properly allocating healthcare resources to optimize value within orthopedic surgery. Establishing time to maximal medical improvement (MMI) can inform clinical decision-making and practice guidelines. PURPOSE We sought (1) to evaluate the time to MMI as predicted by commonly used patient-reported outcome measures (PROMs) for evaluation of shoulder stabilization and (2) to evaluate typical time to return to sports and employment following surgery. METHODS A systematic review of the Medline database was conducted to identify outcome studies reporting sequential follow-up at multiple time points, up to a minimum of 2 years after shoulder stabilization surgery. The included studies examined the outcomes of arthroscopic or open surgical techniques on anterior instability. Clinically significant improvements were evaluated utilizing the minimal clinically important difference specific to each PROM. Secondary outcomes included range of motion, return to sport/work, and recurrent instability. RESULTS Ten studies comprising 590 surgically managed cases of anterior shoulder instability were included (78% arthroscopic, 22% open). Clinically significant improvements in PROMs were achieved up to 1 year post-operatively for Rowe, Western Ontario Instability Index (WOSI), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores. For the three most utilized tools (Rowe, WOSI, ASES), the majority of improvement occurred in the first 6 post-operative months. Clinically significant improvements in Constant Score and Oxford Shoulder Instability Score (OSIS) were achieved up to 6 months and 2 years after surgery, respectively. No clinically significant improvements were achieved on the Disabilities of the Arm, Shoulder, and Hand (DASH) tool. CONCLUSION Maximal medical improvement as determined by commonly utilized PROMs occurs by 1 year after operative management of anterior shoulder instability. The DASH tool does not appear to demonstrate a reliable time frame for clinically significant outcome improvement.
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Affiliation(s)
- Bhavik H. Patel
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY USA
| | | | | | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL USA
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11
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Lee SJ, Kim JH, Gwak HC, Kim CW, Lee CR, Jung SH, Kwon CI. Influence of Glenoid Labral Bumper Height and Capsular Volume on Clinical Outcomes After Arthroscopic Bankart Repair as Assessed With Serial CT Arthrogram: Can Anterior-Inferior Volume Fraction Be a Prognostic Factor? Am J Sports Med 2020; 48:1846-1856. [PMID: 32516051 DOI: 10.1177/0363546520924809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic labral repair combined with capsular plication decreases joint volume and restores glenoid labral bumper height; thus, the procedure helps decrease capsular redundancy. However, the decreased volume and restored glenoid labral bumper height could change over time, which could influence the outcome of the operation. PURPOSE To (1) measure glenoid labral bumper height and capsular volume quantitatively in serial computed tomography arthrography (CTA) and evaluate the relationship between bumper height and joint volume and (2) compare the difference in bumper height and joint volume between groups with and without apprehension after arthroscopic Bankart repair. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients who had undergone arthroscopic Bankart repair between January 2012 and June 2016, and were assessed by CTA 3 to 6 months and 12 to 18 months after the operation were included. An image reconstruction program (3-dimensional slicer) was used to calculate inferior, anterior-inferior, and posterior-inferior joint volumes; the ratio of the anterior-inferior volume to the inferior volume was defined as the anterior-inferior volume fraction (VFAI). We also measured glenoid labral bumper height at the 5-, 4-, and 3-o'clock positions. RESULTS A total of 50 patients were enrolled as study participants (mean age, 25.2 ± 9.29 years). Of these, 10 patients had either redislocation or apprehension, and 40 patients had neither. A significant correlation was observed between 5-o'clock glenoid labral bumper height and VFAI on early CTA (3-6 months) and late CTA (12-18 months) (early CTA: Pearson coefficient, -0.335, P = .040; late CTA: Pearson coefficient, -0.468, P = .003). VFAI at the early CTA was 42.20 ± 10.15 in the group with apprehension and 33.49 ± 9.66 in the group without apprehension; a significant difference was observed. VFAI at the late CTA was 45.84 ± 11.97 in the group with apprehension and 37.65 ± 9.70 in the group without apprehension and thus showed a significant difference between the 2 groups. However, the 3-, 4-, and 5-o'clock glenoid labral bumper heights on early and late CTAs did not show a statistically significant difference between the 2 groups. CONCLUSION Early postoperative VFAI is related to postoperative apprehension and redislocation and might be reduced by increasing the 5-o'clock glenoid labral bumper height.
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Affiliation(s)
- Seung-Jun Lee
- Department of Orthopedic Surgery, Busan Central Hospital, Busan, Republic of Korea
| | - Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Heui-Chul Gwak
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chang-Wan Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chang-Rack Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Soo-Hwan Jung
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Chung-Il Kwon
- Department of Orthopedic Surgery, Busan Central Hospital, Busan, Republic of Korea
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Xu S, Chen JY, Hao Y, Chang CCP, Lie DTT. Threshold scores for treatment success after arthroscopic bankart repair using Oxford Shoulder Instability Score, Constant-Murley Score, and UCLA shoulder score. J Orthop 2020; 22:242-245. [PMID: 32425425 DOI: 10.1016/j.jor.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 11/16/2022] Open
Abstract
Aim To determine the threshold score for Oxford Shoulder Instability Score (OSIS), Constant-Murley score (CMS), and University of California Los Angeles (UCLA) shoulder score that predict treatment success after arthroscopic bankart repairs. Methods 77 patients were followed up for 12-mmonth. Threshold scores were determined by Receiver Operating Characteristic (ROC) analyses with treatment success defined as improvement in pain, no re-dislocation, expectation and satisfaction met. Results The follow threshold scores were identified:6-month: OSIS 35, CMS 68,UCLA 2612-month: OSIS 24, CMS 84, UCLA 33. Conclusion OSIS, CMS, and UCLA are good predictors of treatment success after arthroscopic bankart repair.Level of EvidenceIII.
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Affiliation(s)
- Sheng Xu
- Singapore General Hospital, Department of Orthopedic Surgery, Singapore
| | | | - Ying Hao
- Singapore General Hospital, Health Service Research Institute, Singapore
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Sebastiá-Forcada E, Martínez-Rico S, Vizcaya-Moreno M, Lizaur-Utrilla A. Prospective study on effectiveness and safety of arthroscopic Bankart using a single anterior portal for patients with anterior shoulder instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Lee M, Chen J, Lie D. Editorial Commentary: Outcomes in Arthroscopic Rotator Cuff Repairs: Are We Treating Patients or Radiographs? Arthroscopy 2019; 35:2948-2949. [PMID: 31604516 DOI: 10.1016/j.arthro.2019.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 02/02/2023]
Abstract
Rotator cuff tears are among the most common disorders of the shoulder girdle requiring surgical intervention, and it is no surprise that orthopaedic surgeons have searched far and wide for means to improve on rotator cuff repair outcomes. Radiological parameters such as the critical shoulder angle have recently emerged and have been associated with the presence of degenerative rotator cuff tears. However, their true impact on postoperative outcomes are still unclear. Although radiological parameters, because of their objectivity, will always remain a critical part of a surgeon's preoperative assessment, we must remember that ultimately we are treating patients and not radiographs.
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Liu T, Yamamoto N, Shinagawa K, Hatta T, Itoi E. Curved-guide system is useful in achieving optimized trajectory for the most inferior suture anchor during arthroscopic Bankart repair. J Shoulder Elbow Surg 2019; 28:1692-1698. [PMID: 31447122 DOI: 10.1016/j.jse.2019.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/27/2019] [Accepted: 03/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND A curved-drill guide system was recently introduced to achieve a better trajectory for a low anteroinferior anchor during arthroscopic Bankart repair. However, the clinical performance of such a device remains unclear. The purpose of this study was to evaluate the trajectory and position of the low anteroinferior suture anchor with use of the curved-guide system in clinical cases. METHODS We enrolled 41 cases of arthroscopic Bankart repair in this study. Of these cases, 9 were repaired using the curved drill guide whereas 32 were repaired using a conventional straight guide. Postoperative computed tomography scans were obtained, and 3-dimensional models of the scapula were reconstructed. Notable perforations of the opposite cortex by the most inferior anchors were recorded. The clock-face angle, insertion angle, and insertion distance were measured. RESULTS The anchor perforation rate in the curved-guide group (11%) was significantly lower than that in the straight-guide group (56%) (P = .02). The insertion distance in the curved-guide group was significantly shorter than that in the straight-guide group (4.0 ± 1.6 mm vs. 7.0 ± 2.4 mm, P < .01). The clock-face angle and insertion angle were significantly greater in the perforated straight-guide group than in the nonperforated groups. The percentage of anchors in the absolute safe zone (clock-face angle > 135° and < 165° and insertion angle < 100°), where no anchors perforated, was greater in the curved-guide group than the straight-guide group. CONCLUSION Compared with the conventional straight guide, the curved-guide system provides better placement of the most inferior suture anchor during arthroscopic Bankart repair.
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Affiliation(s)
- Tong Liu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Sebastiá-Forcada E, Martínez-Rico S, Vizcaya-Moreno MF, Lizaur-Utrilla A. Prospective study on effectiveness and safety of arthroscopic Bankart using a single anterior portal for patients with anterior shoulder instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:431-438. [PMID: 31285179 DOI: 10.1016/j.recot.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 01/24/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of the arthroscopic Bankart repair technique using a single anterior portal in patients with anterior shoulder instability. PATIENTS AND METHODS Prospective study of 82 patients who underwent arthroscopic Bankart repair using a single anterior portal. Comparison with a historical series of 69 patients treated with two anterior portals. The patients were evaluated by the Rowe scale, and DASH (Disability of the Arm, Shoulder and Hand) and OIS (Oxford Instability Shoulder) questionnaires, range of motion and visual analogue scales for pain and patient satisfaction. RESULTS After a mean follow-up of 36 months, there were no significant differences between groups regarding clinical or functional scores, quality of life or patient satisfaction. Surgical time was significantly shorter in the 1-portal group. In group 1-portal there were 2 patients with neurapraxias and 2 re-dislocations, while in group 2-portals were 1 and 2, respectively. The worst functional results were associated with the presence of a type III SLAP lesion. CONCLUSIONS Both techniques were satisfactory regarding functional outcomes and complications, except for type III SLAP lesions. Using only one anterior portal, the surgical time was shorter, and the costs were lower when dispensing with a second cannula and a suture passing instrument.
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Affiliation(s)
- E Sebastiá-Forcada
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España
| | - S Martínez-Rico
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España
| | - M F Vizcaya-Moreno
- Unidad de Investigación, Facultad de Ciencias de la Salud, Universidad de Alicante, San Vicente del Raspeig, Alicante, España
| | - A Lizaur-Utrilla
- Unidad de Miembro Superior, Hospital Universitario de Elda, Elda, Alicante, España.
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Park I, Kang JS, Jo YG, Shin SJ. Factors Related to Patient Dissatisfaction Versus Objective Failure After Arthroscopic Shoulder Stabilization for Instability. J Bone Joint Surg Am 2019; 101:1070-1076. [PMID: 31220023 DOI: 10.2106/jbjs.18.01243] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND After arthroscopic stabilization procedures for recurrent anterior shoulder instability, patients are not always satisfied with their shoulder, even when the operation successfully restored stability. The aim of this study was to evaluate the factors associated with subjective patient dissatisfaction after arthroscopic stabilization procedures for recurrent anterior shoulder instability and to compare these factors with those associated with objective surgical failure. METHODS A total of 195 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability were included in this study. At the 2-year postoperative visit, subjective patient dissatisfaction was assessed with a 15-point scale. Objective surgical failure was defined as postoperative dislocation or subluxation events requiring revision surgery. Several factors, including age at the first dislocation, age at the time of the operation, presence of an off-track Hill-Sachs lesion, width of the Hill-Sachs lesion, size of the glenoid bone defect, and number of instability events, were recorded. Multivariable linear regression analysis and multivariable logistic regression analysis were performed using a backward stepwise procedure as the variable selection method. RESULTS Fifteen patients (7.7%) had recurrent instability requiring revision surgery. In the group of 180 patients without surgical failure, the width of the Hill-Sachs lesion (regression coefficient: 0.052, p = 0.011) and number of instability events (regression coefficient: 0.103, p = 0.029) were positively correlated with subjective patient dissatisfaction, whereas concomitant repair of a SLAP (superior labrum anterior-posterior) lesion showed negative correlation (regression coefficient: -0.926, p = 0.004). In the total cohort of patients, objective surgical failure was correlated with the age at the time of the operation (odds ratio [OR]: 0.851, p = 0.042), size of the glenoid bone defect (OR: 1.172, p < 0.001), and number of instability events (OR: 1.147, p = 0.048). Other variables, including an off-track Hill-Sachs lesion or a concomitant remplissage procedure, were not correlated with subjective patient dissatisfaction or objective surgical failure. CONCLUSIONS Factors related to subjective patient dissatisfaction differed from those related to objective surgical failure. For a better understanding of the clinical outcomes after surgery, surgeons should assess the factors that correlate with subjective patient dissatisfaction and objective surgical failure. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
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Kennedy MI, Murphy C, Dornan GJ, Moatshe G, Chahla J, LaPrade RF, Provencher MT. Variability of Reporting Recurrence After Arthroscopic Bankart Repair: A Call for a Standardized Study Design. Orthop J Sports Med 2019; 7:2325967119846915. [PMID: 31192268 PMCID: PMC6543797 DOI: 10.1177/2325967119846915] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background High recurrence rates have been reported after anterior shoulder dislocations, regardless of the treatment utilized. However, the definition of recurrent instability has been inconsistent, making a comparison between studies difficult. Purpose To report on the nature with which the rate of recurrent instability is reported after arthroscopic Bankart repair, across all levels of evidence, and to analyze factors that may affect the reported rate of recurrence. Study Design Systematic review; Level of evidence, 4. Methods A systematic review of the literature was performed by searching PubMed, the Cochrane Central Register of Controlled Trials, Embase, and ClinicalTrials.gov for studies published within the dates of January 2008 and September 2018. Studies in English that reported on the recurrence of instability after arthroscopic Bankart repair for anterior shoulder instability were considered for inclusion in this review. A meta-regression was performed to test for a linear association between the reported recurrence rate and several continuous covariates, including mean age at surgery, mean length of follow-up, attrition rate (loss to follow-up percentage), and percentage of male patients. Results A trim-and-fill meta-analysis yielded an estimated overall recurrence rate of 17.4% (95% CI, 14.3%-20.9%). There was a significant difference in the recurrence rate depending on the level of evidence (Q(3) = 10.98; P = .012). Significant associations were found with the recurrence rate through the meta-regression, including a negative association with mean age (P = .009), a positive association with mean follow-up time (P = .002), and a positive association with attrition rate (P = .035). Conclusion A call for standardization is necessary for reporting outcomes of anterior instability after arthroscopic Bankart repair, especially with regard to the reporting of recurrence/failure rates, with careful consideration of the effects that may occur from patient demographics and study design. With no current recommendations for deeming failure, we suggest that all forms of instability be accounted for when determining a failed treatment procedure, with future studies placing an emphasis on greater control of the study design.
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Affiliation(s)
| | - Colin Murphy
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Gilbert Moatshe
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, USA
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Abstract
One of the joys of the editorial team is selecting the annual Journal Awards. Recognizing research excellence is what we do. If a manuscript was ultimately selected for publication, it is already excellent, as we publish less than 20% of original scientific article submissions, and we received more than 1,300 such submissions in 2017. To be one of our award winners is to be truly "elite."
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Pogorzelski J, Millett PJ. Editorial Commentary: Postoperative Outcomes-Are We Asking the Right Questions? Shoulder Arthroscopy Patient Quality of Life Correlates With Joint-Specific Outcome and Is Predicated on Patient Expectation. Arthroscopy 2017; 33:1786-1787. [PMID: 28969813 DOI: 10.1016/j.arthro.2017.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 02/02/2023]
Abstract
Patient-reported outcomes are, by definition, subjective, and there is consensus that individual patient expectations have a significant effect on the postoperative outcome after shoulder arthroscopy. Most of the outcomes in orthopaedic surgery are measured either in terms of functional scores assessing only one joint or as disease or condition-specific outcomes. As such, there exists a growing interest developing better tools to measure quality-of-life outcome scores as an assessment of overall patient health and satisfaction. Recent research shows that quality-of-life outcome measures correlate with joint-specific and functional outcomes after arthroscopic Bankart repair. We also personally believe that quality-of-life scores should become a standard outcome assessment measurement in orthopaedic surgery because while we perform surgery on the joint, we take care of the whole patient.
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