The Relationship Between Achieving the Minimal Clinically Important Difference and Patient-Reported Satisfaction After Arthroscopic Superior Capsular Reconstruction With a Fascia Lata Autograft for Irreparable Massive Rotator Cuff Tears.

Background: Surgeons used the minimal clinically important difference (MCID) to interrogate outcomes-using patient-reported outcomes-to determine whether a patient can achieve clinical benefit after orthopaedic surgery. However, it is proposed to be crucial to separate the idea of meeting a clinically established threshold of patient-reported outcome measures (PROMs), which could truly predict patient-reported satisfaction with that outcome.

Purpose: To investigate the association between achieving MCID and patient-reported satisfaction after arthroscopic superior capsular reconstruction with fascia lata autografts for irreparable massive rotator cuff tears.

Study Design: Case-control study; Level of evidence, 3.

Methods: A total of 62 patients with ≥2-year follow-up and receiving questionnaires were included. PROMs were collected pre- and postoperatively, including pain visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores. MCIDs were determined using the sensitivity- and specificity-based approaches. Patient-reported satisfaction was evaluated with the following question: "Are you satisfied with your superior capsular reconstruction surgery (yes/no)?" The association between achieving MCID and patient-reported satisfaction was evaluated.

Results: All 3 scores had acceptable area under the curve values (>0.7) for MCID. The MCID values were 4.5, 14.5, and 25.0 for the VAS, ASES, and SANE scores, respectively. Patients achieving MCID for PROMs had significantly greater improvement levels in the other clinical outcome scores than their counterparts ( < .05), except for the VAS score that demonstrated no difference between patients achieving and not achieving the MCID for SANE score ( = .07). Achieving MCID for PROMs was associated with a significantly higher proportion of patients feeling satisfied with the outcomes than the group failing to achieve the MCID (all < .05). However, the percentages of patients who failed to achieve MCID for pain VAS, ASES, and SANE scores reported satisfaction with their results at 63.3%, 54.5%, and 59.1%, respectively.

Conclusion: Achieving MCID thresholds on the VAS, ASES, and SANE scores were predictive of patient-reported satisfaction after arthroscopic superior capsular reconstruction 2 years postoperatively. However, half of the patients who failed to achieve MCID were still satisfied, regardless of clinical outcome improvements. Surgeons may need to be careful when consulting patients about expected outcomes, and patients need to set reasonable expectations based on their preoperative condition.