BACKGROUND: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. PURPOSE: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. RESULTS: The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. CONCLUSION: After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.
BACKGROUND: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. PURPOSE: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care. Given that arthroscopic rotator cuff repair is a common ambulatory orthopaedic procedure, the purpose of this study was to establish a time frame for maximal medical improvement (the state when improvement has stabilized) after arthroscopic rotator cuff repair. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was conducted, identifying studies reporting sequential patient-reported outcomes up to a minimum of 2 years after arthroscopic rotator cuff repair. The primary clinical outcome was patient-reported outcomes at 3-month, 6-month, 1-year, and 2-year follow-up. Secondary clinical outcomes included range of motion, strength, retears, and complications. Clinically significant improvement was determined between various time intervals by use of the minimal clinically important difference. RESULTS: The review included 19 studies including 1370 patients who underwent rotator cuff repair. Clinically significant improvement in patient-reported outcomes was seen up to 1 year after rotator cuff repair, but no clinical significance was noted from 1 year to 2 years. The majority of improvement in strength and range of motion was seen up to 6 months, but no clinically meaningful improvement was seen thereafter. All reported complications and the majority of retears occurred within 6 months after rotator cuff repair. CONCLUSION: After rotator cuff repair, a clinically significant improvement in patient-reported outcomes, range of motion, and strength was seen up to 1 year after surgery, but not beyond this. This information is important not only to establish appropriate patient expectations but also to determine a time frame for outcome collection after surgery to better define value in orthopaedic care.
Entities:
Keywords:
maximal medical improvement; minimal clinically important difference; rotator cuff repair; value based health care
Authors: Brandon C Cabarcas; Alexander Beletsky; Joseph Liu; Anirudh K Gowd; Brandon J Manderle; Matthew Cohn; Nikhil N Verma Journal: Arthrosc Sports Med Rehabil Date: 2021-05-29
Authors: Bhavik H Patel; Yining Lu; Avinesh Agarwalla; Richard N Puzzitiello; Benedict U Nwachukwu; Gregory L Cvetanovich; Jorge Chahla; Brian Forsythe Journal: HSS J Date: 2020-09-10
Authors: Amos Song; Joshua DeClercq; Gregory D Ayers; Laurence D Higgins; John E Kuhn; Keith M Baumgarten; Elizabeth Matzkin; Nitin B Jain Journal: J Bone Joint Surg Am Date: 2020-07-01 Impact factor: 6.558
Authors: Anirudh K Gowd; Gregory L Cvetanovich; Joseph N Liu; Benedict U Nwachukwu; Brandon C Cabarcas; Brian J Cole; Brian Forsythe; Anthony A Romeo; Nikhil N Verma Journal: Orthop J Sports Med Date: 2019-10-29
Authors: Brian Forsythe; Avinesh Agarwalla; Richard N Puzzitiello; Bhavik H Patel; Yining Lu; Nikhil N Verma; Anthony A Romeo; Brian J Cole Journal: Orthop J Sports Med Date: 2020-01-03