How Long Does It Take to Achieve Clinically Significant Outcomes After Isolated Biceps Tenodesis?

Background

Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined.

Purpose

To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT.

Study Design

Case series; Level of evidence, 4.

Methods

The American Shoulder and Elbow Surgeons score (ASES), the Single Assessment Numeric Evaluation, and the Constant-Murley score (CMS) were administered preoperatively and at 6 and 12 months postoperatively to patients undergoing isolated BT between 2014 and 2018 at our institution. Cumulative probabilities for achieving MCID, SCB, and PASS were calculated using Kaplan-Meier survival analysis. Weibull parametric regression evaluated the hazard ratios (HRs) of achieving earlier MCID, SCB, and PASS.

Results

Overall cohort (N = 190) achievement rates ranged between 77.8% and 83.2% for MCID, between 42.2% and 80.2% for SCB, and between 59.7% and 62.9% for PASS. Median achievement time was 5.3 to 6.1 months for MCID, 5.9 to 6.4 months for SCB, and 6.07 to 6.1 months for PASS. Multivariate Weibull parametric regression identified older age, male sex, higher body mass index, preoperative thyroid disease, smoking history, and higher preoperative CMS as predictors of delayed CSO achievement (HR, 1.01-6.41), whereas normal tendon on arthroscopy, defined as absence of tenosynovitis or tendon tear on arthroscopy, predicted earlier CSO achievement (HR, 0.19-0.46). Location of tenodesis and worker compensation status did not significantly predict the time to achieve CSOs on multivariate analysis.

Conclusion

After isolated BT, patients can expect to attain CSO by 13 months postoperatively, with most patients achieving this between 5 and 8 months. Patients tend to take longer to achieve PASS than MCID and SCB.

Informations de copyright

© The Author(s) 2022.

Déclaration de conflit d'intérêts

One or more of the authors has declared the following potential conflict of interest or source of funding: B.U.N. has received grant support from Arthrex, education payments from Arthrex and Smith & Nephew, and hospitality payments from Stryker, Wright Medical, and Zimmer Biomet. N.N.V. has received research support from Arthrex, Arthrosurface, Athletico, ConMed Linvatec, DJO, Miomed, Mitek, Ossur, and Smith & Nephew; consulting fees from Arthrex, Minivasive, and Orthospace; and royalties from Smith & Nephew and Vindico Medical-Orthopedics Hyperguide; and has stock/stock options in Cymedica, Minivasive, and Omeros. B.J.C. has received research support from Aesculap/B. Braun, Arthrex, and Regentis; education payments from Medwest; consulting fees from Acumed, Aesculap Biologics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Smith & Nephew, Vericel, and Zimmer Biomet; speaking fees from Arthrex and Lifenet Health; hospitality payments from GE Healthcare; honoraria from Vericel; and royalties from Arthrex and DJO; and has stock/stock options in Ossur and Regentis. B.F. has received research support from Arthrex, Smith & Nephew, and Stryker; education payments from Medwest; consulting fees from Sonoma Orthopedics and Stryker; royalties from Elsevier; and honoraria from Arthrosurface; and has stock/stock options in Jace Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.