The Effect of Hand Dominance on Functional Outcome Following Single Row Rotator Cuff Repair

Patient Preferences in Short-Interval Staged Bilateral Rotator Cuff Repair

The decision to seek and undergo treatment for bilateral rotator cuff tears is often complex. The purpose of this study was to investigate patient preferences for undergoing short-interval staged bilateral rotator cuff repair; timing of surgeries; and order of surgeries. A retrospective analysis was performed for patients who underwent bilateral arthroscopic rotator cuff repairs within 12 months at a single institution. Postoperative patient-reported outcomes, satisfaction, and decision-making factors were collected via REDCap surveys. Ninety patients were included (63 men and 27 women; mean age, 58.1 years). The mean time between surgeries was 7.33 months. Forty-two percent of patients had left rotator cuff repair first. Patients reported a mean satisfaction score of 91.6 of 100 with the order of the surgeries and 87.3 of 100 with the timing of the surgeries. Mean postoperative American Shoulder and Elbow Surgeons standardized assessment scores were 94.6 and 93.7 (left vs right shoulder first, respectively) for left shoulders and 94.2 and 93.9 (left vs right shoulder first, respectively) for right shoulders. Mean postoperative Single Assessment Numeric Evaluation scores were 86.5 and 83.9 (left vs right shoulder first, respectively) for left shoulders and 87.3 and 86.0 (left vs right shoulder first, respectively) for right shoulders. Decision-making factors noted as highly important included night pain, function, surgeon recommendation, and daily pain. Most patients who undergo short-interval staged bilateral rotator cuff repair are satisfied with the order and timing of their surgery. Decision-making factors such as night pain and functional limitation play a key role in the timing and order of bilateral rotator cuff repairs. [Orthopedics. 2023;46(6):e347-e352.].

Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) of upper extremity PROMIS scores following arthroscopic rotator cuff repairs

PURPOSE

To calculate and determine what factors are associated with achieving the Minimal Clinically Important Difference (MCID) and the Substantial Clinical Benefit (SCB) of Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Testing v2.0 (UE), Pain Interference (P-Interference), and Pain Intensity (P-Intensity) in patients undergoing arthroscopic rotator cuff repair (aRCR).

METHODS

The change in PROMIS scores representing the optimal cutoff for a ROC curve with an area under the curve analysis was used to calculate the anchor-based MCID and SCB. To assess the responsiveness of each PROM, effect sizes and standardized response means (SRM) were calculated. To identify factors associated with attaining the MCID and SCB, univariate and multivariate logistic regression analyses were performed.

RESULTS

A total of 323 patients with an average age of 59.9 ± 9.5 were enrolled in this study, of which, 187/323 [57.9%] were male and 136/323 [42.1%] were female. The anchor-based MCID for PROMIS UE, P-Interference, and P-Intensity was: 9.0, 7.5, and 11.2, respectively. The respective SCB was 10.9, 9.3, and 12.7. Effect size and SRM were: PROMIS UE (1.4, 1.3), P-Interference (1.8, 1.5), and P-Intensity (2.3, 2.0). Lower preoperative P-Intensity scores (p = 0.02), dominant arm involvement (p = 0.03), and concomitant biceps tenodesis (p = 0.03) were associated with patients achieving the SCB for PROMIS UE.

CONCLUSION

A large responsiveness for each of the PROMIS instruments due to the majority of patients reporting great improvement after aRCR and a small standard deviation across all outcome measures was shown in our study. Lower preoperative P-Intensity scores and concomitant biceps tenodesis were associated with higher odds of achieving the SCB for PROMIS UE. The knowledge of MCID and SCB values for PROMIS instruments will allow the surgeon to determine whether the improvements in the PROMIS scores after aRCR are clinically meaningful.

LEVEL OF EVIDENCE

Level III.

The Influence of Hand Dominance in Wrist Fracture Post-Operative Functional Evaluation

Sensorimotor testing is used to measure outcomes in surgery, to document results of treatment and rehabilitation, and to compare results between surgeons, therapists, and institutions. When performing sensorimotor testing, failure to address dominant side differences may cause a bias in evaluation of outcomes. This study evaluated the effect of hand dominance on outcomes testing performed on patients following surgery for distal radius fractures (DRF). We hypothesized that the injured dominant hand will perform differently than the injured non-dominant hand. This is a retrospective study of patients following DRF treated surgically and evaluated in therapy. The patients were evaluated at fixed intervals: initially, at 6 weeks, and at 3 months post-surgery. Testing included grip strength, monofilaments, static and moving 2-point discrimination, Moberg testing, and stereognosis. Sixty patients included 46 (76.6%) females. Age averaged 62.1 (standard deviation: 16.9) years, and 54 were right-handed (90%). There were differences between dominant and non-dominant hand injury in 2 of 9 tests of sensibility for each time period, including little finger monofilament and Moberg testing initially, and moving 2-point discrimination in the little finger, monofilament testing of the thumb at 3 months. Both groups improved between initial and 3-month evaluation without differences in amount of improvement. Despite some significant differences in the applied tests between dominant and non-dominant injured hands, our results do not support correction for hand-dominance when using the described examinations in evaluating outcomes following DRF surgery.

How Is Maximum Outcome Improvement Defined in Patients Undergoing Shoulder Arthroscopy for Rotator Cuff Repair? A 1-Year Follow-Up Study

PURPOSE

To (1) determine the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley subjective score thresholds for achieving maximal outcome improvement (MOI) after arthroscopic rotator cuff repair and (2) identify preoperative predictors of reaching the ASES threshold for achieving MOI.

METHODS

A retrospective cohort study was performed to identify patients undergoing rotator cuff repair at a high-volume institution from January 2014 to January 2017 with a 1-year minimum follow-up. Patient characteristics, as well as preoperative and postoperative outcome scores, were analyzed. MOI for the ASES and SANE score were calculated as previously described, and a receiver operating characteristic (ROC) curve analysis was used to determine thresholds for percentage of maximal improvements for each outcome measure based on a satisfaction anchor question. Last, a logistic regression model was used to identify predictors of reaching the ASES threshold for achieving MOI.

RESULTS

A total of 220 patients were included in the final analysis. There was a statistically significant increase in score average across all 3 outcome measures (P < .001 for all), with 162 (73.6%) patients rating their surgical outcome as satisfactory at 1-year follow-up. The ROC curve analysis demonstrated that ASES, SANE, and Constant-Murley threshold percentages for achieving MOI was 69.5% (area under the curve [AUC], 0.86; 95% confidence interval [CI], 0.81-0.91; P < .001), 75% (AUC, 0.814; 95% CI, 0.758-0.871; P < .001), and 55.1% (AUC, 0.84; 95% CI, 0.783-0.898; P < .001), respectively. Logistic regression demonstrated that workers compensation cases (odds ratio, 0.69; 95% CI, 0.55-0.86; P = .001) and dominant-sided surgery (odds ratio, 0.72; 95% CI, 0.59-0.88; P = .002) were predictors of not achieving maximal improvement on the ASES score.

CONCLUSION

Achieving 69.5% of maximal ASES score improvement or 75% of maximal SANE score improvement is indicative of achieving patient satisfaction after arthroscopic rotator cuff repair. Preoperative variables including workers compensation cases and surgery to the dominant side were predictors of not achieving maximal improvement.

LEVEL OF EVIDENCE

IV, case series.