Establishing procedure-specific minimal clinically important difference and patient acceptable symptom state thresholds after anterior combined latissimus dorsi and teres major tendon transfer for irreparable anterosuperior cuff tears: minimum 5-year outcomes.

BACKGROUND

To date, no prior study has established procedure-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for anterior combined latissimus dorsi and teres major (LDTM) tendon transfer in irreparable anterosuperior rotator cuff tears (IASRCTs). This study aimed to establish these patient-centered benchmarks in a cohort with a minimum 5-year follow-up.

METHODS

We retrospectively reviewed 31 patients (33 shoulders) who underwent a single-stage anterior LDTM transfer for IASRCTs and completed a minimum 5-year follow-up. Patient-reported outcome measures (PROMs) included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, Constant score, and activities of daily living requiring internal rotation (ADLIR) score. The MCID was calculated as one-half of the standard deviation of the change score for each PROMs. PASS thresholds were derived from receiver operating characteristic analysis, using postoperative satisfaction as the external anchor.

RESULTS

At a mean follow-up of 83.0 ± 7.4 months, all PROMs improved significantly (P < .001). Distribution-based MCID thresholds were 10.5 (ASES), 0.9 (VAS), 10.5 (Constant), and 8.6 (ADLIR). Corresponding MCID achievement rates were 77.4%, 87.1%, 74.2%, and 87.1%, respectively. Anchor-based PASS thresholds were ASES ≥75, VAS ≤2, Constant ≥60, and ADLIR ≥78; these were achieved by 64.5%, 80.6%, 77.4%, and 71.0% of patients, respectively. Age showed a significant negative correlation with ASES MCID (r_pb = -0.53, P = .002) and ADLIR MCID (r_pb = -0.41, P = .021). Male sex correlated positively with ASES PASS attainment (φ = 0.46, P = .010). No other baseline variables were significantly associated with MCID or PASS (all P > .05).

CONCLUSION

This study is the first to establish clinically meaningful MCID and PASS thresholds for anterior LDTM transfer in patients with IASRCTs at a minimum 5-year follow-up. Most patients achieved substantial improvements that were deemed acceptable by the patients. These procedure-specific benchmarks provide practical targets for clinical assessment and patient counseling and serve as reference values for future outcome research.