Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptom State Thresholds Following Arthroscopic Capsular Release for the Treatment of Idiopathic Shoulder Adhesive Capsulitis

Abstract

Purpose: To determine the minimal clinically important difference (MCID) and the patient acceptable symptom state(PASS) threshold for the visual analog scale (VAS), Constant, Single Assessment Numeric Evaluation (SANE), and AmericanShoulder and Elbow Surgeons (ASES) scores following arthroscopic capsular release for the treatment of idiopathic shoulderadhesive capsulitis. Methods: A retrospective review of prospective collected data was performed in patients undergoingarthroscopic capsular release for the treatment of idiopathic adhesive capsulitis at a single institution from January 2018through January 2019. Patient-reported outcome measures were collected preoperatively and 6 months’ postoperatively.Delta was defined as the change between preoperative and 6 months’ postoperative scores. Distribution-based andanchored-based (response to a satisfaction question at 1 year) approaches were used to estimate MCIDs and PASS,respectively. The optimal cut-off point where sensitivity and specificity were maximized (Youden index) and the percentageof patients achieving those thresholds were also calculated. Results: Overall, a total of 100 patients without diabetes whounderwent arthroscopic capsular release and completed baseline and 6-month patient-reported outcome measures wereincluded. The distribution-based MCID for VAS, Constant, SANE, and ASES were calculated to be 1.1, 10.1, 9.3, and 8.2,respectively. The rate of patients who achieved MCID thresholds was 98% for VAS, 96% for Constant, 98% for SANE, and99%for ASES. The PASS threshold values for VAS, Constant, and ASES were 2, 70, 80, and 80, respectively. The rateof patients who achieved PASS thresholds was 84% for VAS, 84% for Constant, 89% for SANE, and 78% for ASES.Conclusions: In patients without diabetes and idiopathic adhesive capsulitis, high rates of MCID and PASS thresholds canbe achieved with arthroscopic anteroinferior capsular release Level of Evidence: Level IV, retrospective cohort study.