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Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair

  • SHOULDER
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Previous studies show no difference in clinical outcomes between patients with healed and structurally failed rotator cuff repairs. The objective of this study was to assess ceiling effects when reporting surgical outcomes of arthroscopic rotator cuff repair using four of the currently most popular clinical shoulder outcome scoring systems.

Methods

Ninety-two patients who underwent arthroscopic rotator cuff repair were examined. The simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder rating scale, and Constant–Murley shoulder score were completed 2 years postoperatively. Demographic data of the subjects were analysed using descriptive statistics. The ceiling effects in the outcome data assessed for each scale were estimated based on two previously reported definitions.

Results

The number of patients with the maximum possible score was 31 (33.7%) with the SST, 26 (28.3%) with the ASES score, 28 (30.4%) with the UCLA scale, and 18 (19.6%) with the Constant–Murley score. The standardised distance of the outcome data assessed by the SST, ASES score, UCLA scale, and Constant–Murley scores were 0.92, 0.97, 0.96, and 1.18, respectively.

Conclusion

The SST, ASES score, and UCLA scale evaluated at 2 years postoperatively have substantial ceiling effects showing that the proportion of patients with the maximum possible score is > 20%, and the standardised distance is < 1.0. Researchers should be aware of possible biases due to ceiling effects when interpreting the results of studies investigating the surgical outcomes of arthroscopic rotator cuff repair. It could increase the likelihood of a type II error.

Level of Evidence

IV.

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Abbreviations

ARCR:

Arthroscopic rotator cuff repair

ASES:

American Shoulder and Elbow Surgeons score

ROM:

Range of motion

SB:

Suture-bridge

SR:

Single-row

SST:

Simple shoulder test

UCLA:

University of California at Los Angeles

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Acknowledgements

We thank Amy M. Kwon, PhD in the Biostatistical Consulting and Research Lab, Hanyang University for providing us with statistical comments and drop-out analysis.

Funding

There is no funding statement for the current study.

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Author notes

  1. Bong-Gun Lee and Sung Jae Kim contributed equally to this work as corresponding authors.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 153 Kyoungchun-ro, Guri-si, Gyeonggi-do, 11923, Republic of Korea

    Young-Hoon Jo

  2. Department of Orthopaedic Surgery, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea

    Kwang-Hyun Lee, Soo-Young Jeong & Bong-Gun Lee

  3. Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea

    Sung Jae Kim

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Contributions

BGL and YHJ performed the screening of all titles, abstracts, and full texts. SJK and YHJ participated in data acquisition, performed data analysis. SJK and YHJ drafted the original manuscript. YHJ, KHL, and SYJ participated in the editing of the original manuscript. SJK, YHJ, and BGL participated in the conception and design of the original study. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Sung Jae Kim or Bong-Gun Lee.

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Conflict of interest

All named authors hereby declare that they have no conflicts of interest to disclose.

Ethical approval

All patients provided informed consent for their participation in this study, which was approved by the institutional review board of Hanyang University Hospital (HYUH 2018-07-018).

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Jo, YH., Lee, KH., Jeong, SY. et al. Shoulder outcome scoring systems have substantial ceiling effects 2 years after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 29, 2070–2076 (2021). https://doi.org/10.1007/s00167-020-06036-y

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  • DOI: https://doi.org/10.1007/s00167-020-06036-y

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