Six Months Is the Magic Number for Rotator Cuff Repair

While certain factors can affect how quickly a patient improves after arthroscopic rotator cuff repair, a majority of patients will achieve clinically significant outcomes by 6 months, researchers say.

In the study, “Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair,” published in the December 2020 issue of The American Journal of Sports Medicine, the researchers set out to define the time-dependent nature of the minimal clinically important difference, substantial clinical benefit, and Patient Acceptable Symptomatic State (PASS) after rotator cuff repair and to define what factors affect this time to achieve clinically significant outcomes.

“Recent literature has focused on correlating statistically significant changes in outcomes measures with clinically significant outcomes. Clinically significant outcomes benchmarks are being established for arthroscopic rotator cuff repair, but more remains to be defined about them,” they wrote.

Using an institutional registry, the researchers collected data on 203 patients who underwent arthroscopic rotator cuff repair between 2014 and 2016 and had completed preoperative, 6-month, 1-year, and 2-year Patient-Reported Outcome Measures (PROMS). Their average age was 56.19 ± 9.96 years, and their average body mass index was 30.29 ± 6.49.

Overall, the time of mean achievement of minimal clinically importance difference, substantial clinical benefit, and patient acceptable symptomatic states for American Shoulder and Elbow Surgeons (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 minimal clinical importance difference, substantial clinical benefit, and patient acceptable symptomatic states for Single Assessment Numeric Evaluation (SANE) was 6.25 ± 2.42 months, 7.05 ± 4.10 months, and 9.26 ± 5.89 months, respectively. For the Constant score, the time of mean achievement for each was 6.94 ± 3.85 months, 7.13 ± 4.13 months, and 8.66 ± 5.46 months, respectively.

The researchers found that patients with dominant-sided surgery (HR, 1.363; 95% CI, 1.065-1.745; p = .014) achieved clinically significant outcomes earlier on ASES (American Shoulder and Elbow Surgeons scores), 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 clinically significant outcomes on ASES later.

Patients with distal clavicle excision (HR, 1.484; 95% CI, 1.028-2.143; p = .035) achieved clinically significant outcomes earlier on SANE and on Constant (HR, 1.689; 95% CI, 1.183-2.411; p = .004). However, 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 it later on Constant.

Greater preoperative score was also associated with delayed achievement of clinically significant outcomes 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).

The researchers wrote, “A majority of patients achieved minimal clinically importance difference by 6 months after surgery. Dominant-sided surgery and concomitant distal clavicle excision resulted in faster clinically significant outcomes achievement, while workers’ compensation status, concomitant biceps tenodesis, current smoking, partial-thickness rotator cuff tears, and higher preoperative PROMs resulted in delayed clinically significant outcomes achievement.”