Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure

Abstract

Background:

The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined.

Purpose:

This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS.

Study Design:

Case series; Level of evidence, 4.

Methods:

A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion).

Results:

A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS.

Conclusion:

This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.

Keywords

shoulder instability glenohumeral joint MCID PASS outcome PROM complications

Get full access to this article

View all access options for this article.

References

Arner

Shields

Tanghe

, et al. Shoulder Latarjet surgery shows wide variation in reported indications, techniques, peri-operative treatment, and definition of outcomes, complications, and failure. Arthroscopy. 2022;38(2):522-538.

Berliner

Brodke

Chan

SooHoo

Bozic

. John Charnley Award: preoperative patient-reported outcome measures predict clinically meaningful improvement in function after THA. Clin Orthop Relat Res. 2016;474(2):321-329.

Burkhart

De Beer

Barth

, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy. 2007;23(10):1033-1041.

Cohn

Kunze

Polce

, et al. Establishing clinically significant outcome thresholds for the Single Assessment Numeric Evaluation 2 years following total shoulder arthroplasty. J Shoulder Elbow Surg. 2021;30(4):e137-e146.

Devji

Carrasco-Labra

Qasim

, et al. Evaluating the credibility of anchor based estimates of minimal important differences for patient reported outcomes: instrument development and reliability study. BMJ. 2020;369:M1714.

Di Giacomo

Itoi

Burkhart

. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90-98.

Eguia

Ali

Bansal

McFarland

Srikumaran

. Minimal clinically important differences after subpectoral biceps tenodesis: definition and retrospective assessment of predictive factors. J Shoulder Elbow Surg. 2020;29(7)(suppl):S41-S47.

Foong

Zeng

Goh

, et al. Determining the minimal clinically important difference on the Oxford Shoulder Instability Score in patients undergoing arthroscopic Bankart repair for shoulder instability. Orthop J Sports Med. 2022;10(1):23259671211060023.

Hendy

Padegimas

Kane

, et al. Early postoperative complications after Latarjet procedure: a single-institution experience over 10 years. J Shoulder Elbow Surg. 2021;30(6):e300-e308.

10.

Hurley

Jamal

Ali

, et al. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2019;28(2):e33-e39.

11.

Jaeschke

Singer

Guyatt

. Measurement of health status; ascertaining the minimal clinically important difference. Control Clin Trials. 1989;10(4):407-415.

12.

Joshi

Young

Balestro

Walch

. The Latarjet-Patte procedure for recurrent anterior shoulder instability in contact athletes. Orthop Clin North Am. 2015;46(1):105-111.

13.

Kim

Kholinne

, et al. Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after arthroscopic rotator cuff repair. Am J Sports Med. 2020;48(11):2650-2659.

14.

Kirkley

Griffin

McLintock

. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. Am J Sports Med. 1998;26(6):764-772.

15.

Komorowski

Bai

Cvetkovic

, et al. Secondary analysis of a systematic review: are antifungal noninferiority trials at risk of eroding effectiveness because of biocreep? Antimicrob Agents Chemother. 2022;66(1):e0162721.

16.

Menendez

Neuhaus

van Dijk

Ring

. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res. 2014;472(9):2878-2886.

17.

Michener

McClure

Sennett

. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-594.

18.

Mizuno

Denard

Raiss

Melis

Walch

. Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg. 2014;23(11):1691-1699.

19.

Mologne

Provencher

Menzel

Vachon

Dewing

. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007;35(8):1276-1283.

20.

Nabergoj

Zumstein

Denard

, et al. Capsulolabral reconstruction during the open Latarjet procedure. Arthrosc Tech. 2021;10(11):e2397-e2406.

21.

Norman

Sloan

Wyrwich

. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582-592.

22.

Okoroha

Beck

Nwachukwu

Kunze

Nho

. Defining minimal clinically important difference and patient acceptable symptom state after isolated endoscopic gluteus medius repair. Am J Sports Med. 2019;47(13):3141-3147.

23.

Park

Lee

Hyun

Lee

Shin

. Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability. J Shoulder Elbow Surg. 2018;27(4):579-584.

24.

Park

Shin

. Minimal clinically important differences and correlating factors for the Rowe Score and the American Shoulder and Elbow Surgeons Score after arthroscopic stabilization surgery for anterior shoulder instability. Arthroscopy. 2019;35(1):54-59.

25.

Patel

Agarwalla

, et al. Maximal medical improvement following shoulder stabilization surgery may require up to 1 year: a systematic review. HSS J. 2020;16(suppl 2):534-543.

26.

Privitera

Sinz

Miller

, et al. Clinical outcomes following the Latarjet procedure in contact and collision athletes. J Bone Joint Surg Am. 2018;100(6):459-465.

27.

Puzzitiello

Gowd

Liu

, et al. Establishing minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state after biceps tenodesis. J Shoulder Elbow Surg. 2019;28(4):639-647.

28.

Rabinowitz

Friedman

Eichinger

. Management of glenoid bone loss with anterior shoulder instability: indications and outcomes. Curr Rev Musculoskelet Med. 2017;10(4):452-462.

29.

Rossi

Gorodischer

Brandariz

, et al. High rate of return to sports and low recurrences with the Latarjet procedure in high-risk competitive athletes with glenohumeral instability and a glenoid bone loss <20. Arthrosc Sports Med Rehabil. 2020;2(6):e735-e742.

30.

Rossi

Tanoira

Gorodischer

Pasqualini

Ranalletta

. Recurrence and revision rates with arthroscopic Bankart repair compared with the Latarjet procedure in competitive rugby players with glenohumeral instability and a glenoid bone loss <20. Am J Sports Med. 2021;49(4):866-872.

31.

Shaha

Cook

Rowles

, et al. Clinical validation of the glenoid track concept in anterior glenohumeral instability. J Bone Joint Surg Am. 2016;98(22):1918-1923.

32.

Shaha

Cook

Song

, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719-1725.

33.

Terwee

Roorda

Dekker

, et al. Mind the MIC: large variation among populations and methods. J Clin Epidemiol. 2010;63(5):524-534.

34.

Werthel

Sabatier

Schoch

, et al. Outcomes of the Latarjet procedure for the treatment of chronic anterior shoulder instability: patients with prior arthroscopic Bankart repair versus primary cases. Am J Sports Med. 2020;48(1):27-32.

35.

Williams

Gangel

Arciero

Uhorchak

Taylor

. Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales: outcomes measures after shoulder surgery. Am J Sports Med. 1999;27(2):214-221.

36.

Wong

Friedman

LGM

Garrigues

. Arthroscopic Latarjet: indications, techniques, and results. Arthroscopy. 2020;36(8):2044-2046.

37.

Yang

Mazzocca

Cote

Edgar

Arciero

. Recurrent anterior shoulder instability with combined bone loss: treatment and results with the modified Latarjet procedure. Am J Sports Med. 2016;44(4):922-932.

38.

Yang

Mehran

Mazzocca

, et al. Remplissage versus modified Latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss. Am J Sports Med. 2018;46(8):1885-1891.