Dataset Information

Excellent Correlation of the Patient-Reported Outcomes Measurement Information System Upper Extremity Score With Legacy Outcome Scores Preoperatively and at 1 Year After Arthroscopic Rotator Cuff Repair

ABSTRACT:

Purpose

To assess the preoperative and postoperative performance of the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE, version 2.0) outcome score in comparison to the American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index (WORC) instruments in patients undergoing rotator cuff repair.

Methods

This prospective longitudinal study included 91 patients undergoing rotator cuff repair. Patients completed the PROMIS-UE, ASES, and WORC instruments preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 12 months. The Pearson correlation coefficient (r) between these tools was calculated at each time point. Correlations were graded as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), or poor (<0.4). Responsiveness to change was assessed using the effect size and the standardized response mean. Floor and ceiling effects for each instrument were also assessed.

Results

The PROMIS-UE instrument showed good to excellent correlation with the legacy instruments at all time points. There were variations in the measured effect sizes of the various instruments, with the PROMIS-UE instrument showing responsiveness to change at 3 and 12 months but the ASES and WORC instruments showing responsiveness at 6 weeks, 3 months, and 12 months. Both PROMIS-UE and ASES scores displayed ceiling effects at 12 months.

Conclusions

The PROMIS-UE instrument shows excellent correlation with the ASES instrument and a rotator cuff–specific outcome instrument—the WORC instrument—preoperatively and at 1 year after arthroscopic rotator cuff repair. Variations in the measured effect sizes at different postoperative time points and high ceiling effects of the PROMIS-UE instrument at the 1-year time point may limit its utility in the early postoperative phase and at long-term follow-up after rotator cuff repair.

Clinical Relevance

The performance of the PROMIS-UE outcome measure after arthroscopic rotator cuff repair was investigated.

SUBMITTER: Gordon D

PROVIDER: S-EPMC10123413 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Project description:Arthroscopic rotator cuff repair can be challenging and requires adequate visualization and space. However, the narrow subacromial space can make difficult to perform tendon release and repair under arthroscopy. Inadequate visualization may lead to inaccurate suture placement, compromising the reduction and fixation of the repaired rotator cuff tendons. Manual or mechanical distraction (using an arm positioner) can be used to increase the working space. However, consistent distraction is very difficult to maintain manually over time due to fatigue, whereas mechanical distraction may overstretch the brachial plexus. To overcome these difficulties, we describe a technique using a specific laminar spreader for subacromial distraction during arthroscopic rotator cuff repair. The arthroscopic laminar spreader, inserted into the subacromial space, is used to distract the humeral head inferiorly from the acromion, improving subacromial space visualization and enabling easily rotator cuff release and repair. The shoulder distraction device improves the surgeon’s performance without surgical assistance and allows reducing the operative time with safety. It can be also used anteriorly (to repair the subscapularis) or posteriorly (to repair the infraspinatus and teres minor) or to perform other procedures like superior capsular reconstruction or additional patch. Technique Video Video 1 Arthroscopic rotator cuff tear repair using an arthroscopic laminar spreader: single-row (tension-band suture) placing anchors in the lateral part of the greater tuberosity. Even though acromioplasty has been performed, there is little space to place the sutures through the cuff tendons. The arthroscopic laminar spreader is placed between the acromion and the tendon of the cuff through the anterolateral portal. Introducing the suture hook through the anteromedial portal, it becomes easy to pass the suture through the tendon because the tendon is under pressure with the laminar spreader. Classical repair procedure is shown, using a grasper to retrieve one of the anchor sutures and the polydioxanone suture, which is used as a shuttle to pass it through the tendon. Both strands of sutures are tied with the use of a sliding-locking knot. The laminar spreader is introducing again for the second suture. The arthroscopic laminar spreader opened more than 4 cm. Under fluoroscopic view, the subacromial space increased with the use of the spreader.