Poster 128: Time to Achievement of Clinically Significant Outcomes Following Open Latarjet
Authors: Gamsarian Vahram , Mirle Vikranth R. , Khazi-Syed Daanish , Chang Joshua , Brusalis Christopher M. , Yanke Adam B. , Cole Brian J. , Verma Nikhil N. , Nicholson Gregory P. , Garigues Grant E. , Forsythe Brian 
Published: August 2024

Objective:

To comprehensively define the time required to achieve outcomes (CSOs) after open Latarjet. The primary outcome was to identify an evidence-based timepoint for functional recovery, including the time needed to attain minimally clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for open Latarjet.

Methods:

Patients who underwent open Latarjet between 2016 and 2022 were collected. Those with completed preoperative and at least 1 post-operative (3-month, 6-month, 1 year, and 2 years) Patient-Reported Outcome Measures (PROMs), including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), or Western Ontario Shoulder Instability (WOSI) were included. Exclusion criteria included patients with significant concomitant procedures, or prior ipsilateral Latarjet procedure. MCID and PASS for each PROM were identified from prior literature and utilized as a threshold needed to attain functional recovery. The time needed to achieve CSO was then calculated and plotted using Kaplan-Meier survival analysis. Hazard ratios from multivariate Cox regression identified demographic and intraoperative factors predictive of the delayed time required to achieve MCID and PASS.

Results:

The average patient was 27 years old, male (85%), and white (87%). The majority of patients (62%) had prior ipsilateral arthroscopic instability repair, which had either failed to resolve subluxation symptoms or was successful for an extended period of time, until the patient suffered subsequent acute trauma. Of the 79 included patients, 69 patients had completed SANE forms, and 43 had completed WOSI forms. Patients attained SANE achievement rates of 68% for MCID and 49% for PASS, and WOSI achievement rates of 83.7% for MCID and 55.8% for PASS. Median achievement time across all surveys (SANE, WOSI, and ASES) ranged between 5.0-5.7 months for MCID, and between 5.2–5.9 months for PASS.  Averages for achievement time for MCID ranged from 5.8–7.7 months, and for PASS from 6.4–8.2 months, in respective PRO surveys.  Multivariate Cox regression identified workers’ compensation status, AC joint tenderness, and 3 prior shoulder dislocations as predictors of early clinically significant outcome achievement (hazard ratio: 3.20-43.2), whereas severe bone loss, higher preoperative scores, and root and flap tears predicted delays in clinically significant outcome achievement (hazard ratio: 0.17-0.82).

Conclusions:

The majority of patients (57.5%) undergoing open Latarjet achieved benefit within 6 months of surgery (overall median: 5.5 months; overall average: 7.4 months), with diminishing proportions at later timepoints. Several patient conditions that could be used as proxies for severity at presentation (bone loss, 2+ AC joint tenderness, and several dislocation events) illustrated improved time to CSO, specifically for MCID, but not for PASS. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving open Latarjet.