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

Yining Lu; Avinesh Agarwalla; Ophelie Lavoie-Gagne; Bhavik H Patel; Alexander Beletsky; Benedict U Nwachukwu; Nikhil N Verma; Brian J Cole; Brian Forsythe

doi:10.1177/23259671221070857

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

Orthop J Sports Med. 2022 Mar 8;10(3):23259671221070857. doi: 10.1177/23259671221070857. eCollection 2022 Mar.

Authors

Yining Lu¹, Avinesh Agarwalla², Ophelie Lavoie-Gagne³, Bhavik H Patel⁴, Alexander Beletsky⁵, Benedict U Nwachukwu⁶, Nikhil N Verma⁷, Brian J Cole⁷, Brian Forsythe⁷

Affiliations

¹ Department of Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA.
² Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, USA.
³ Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁴ Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
⁵ Riverside Community Hospital, Riverside, Califonia, USA.
⁶ Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
⁷ Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA.

Abstract

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.

Keywords: ASES; biceps tenodesis; clinically significant outcomes; minimum clinically important difference; timeline.