Arthroscopic Rotator Cuff Repair Metrics: Establishing Face, Content, and Construct Validity in a Cadaveric Model

Richard L Angelo; Joe Tauro; Pat St Pierre; Glen Ross; Ilya Voloshin; Ben Shafer; Richard K N Ryu; Louis McIntyre; Anthony G Gallagher

doi:10.1016/j.arthro.2019.07.016

Arthroscopic Rotator Cuff Repair Metrics: Establishing Face, Content, and Construct Validity in a Cadaveric Model

Arthroscopy. 2020 Jan;36(1):71-79.e1. doi: 10.1016/j.arthro.2019.07.016.

Authors

Richard L Angelo¹, Joe Tauro², Pat St Pierre³, Glen Ross⁴, Ilya Voloshin⁵, Ben Shafer⁶, Richard K N Ryu⁷, Louis McIntyre⁸, Anthony G Gallagher⁹

Affiliations

¹ ProOrtho Clinic, Kirkland, Washington, U.S.A.. Electronic address: rlamdortho@comcast.net.
² Department of Orthopedic Surgery, Rutgers Medical School, Newark, New Jersey, U.S.A.
³ Desert Orthopedic Center, Shoulder and Elbow Service, Palm Desert, California, U.S.A.
⁴ Pro Ortho Sports, Sports Medicine, New England Baptist, Boston, Massachusetts, U.S.A.
⁵ Department of Orthopedics, Shoulder and Elbow Division, University of Rochester, Rochester, New York, U.S.A.
⁶ Washington Orthopaedics and Sports Medicine, Washington, D.C., U.S.A.
⁷ The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.
⁸ Department of Orthopedic Surgery, Zucker School of Medicine, Hempstead, New York, U.S.A.
⁹ Faculty of Life and Health Sciences, Ulster University, Londonderry, Northern Ireland.

PMID: 31864602
DOI: 10.1016/j.arthro.2019.07.016

Abstract

Purpose: To create and determine face validity and content validity of arthroscopic rotator cuff repair (ARCR) performance metrics, to confirm construct validity of the metrics coupled with a cadaveric shoulder, and to establish a performance benchmark for the procedure on a cadaveric shoulder.

Methods: Five experienced arthroscopic shoulder surgeons created step, error, and sentinel error metrics for an ARCR. Fourteen shoulder arthroscopy faculty members from the Arthroscopy Association of North America formed the modified Delphi panel to assess face and content validity. Eight Arthroscopy Association of North America shoulder arthroscopy faculty members (experienced group) were compared with 9 postgraduate year 4 or 5 orthopaedic residents (novice group) in their ability to perform an ARCR. Instructions were given to perform a diagnostic arthroscopy and a 2-anchor, 4-simple suture repair of a 2-cm supraspinatus tear. The procedure was videotaped in its entirety and independently scored in blinded fashion by trained, paired reviewers.

Results: Delphi panel consensus for 42 steps and 66 potential errors was obtained. Overall performance assessment showed a mean inter-rater reliability of 0.93. Novice surgeons completed 17% fewer steps (32.1 vs 37.5, P = .001) and enacted 2.5 times more errors than the experienced group (6.21 vs 2.5, P = .012). Fifty percent of the experienced group members and none of the novice group members achieved the proficiency benchmark of a minimum of 37 steps completed with 3 or fewer errors.

Conclusions: Face validity and content validity for the ARCR metrics, along with construct validity for the metrics and cadaveric shoulder, were verified. A proficiency benchmark was established based on the mean performance of an experienced group of arthroscopic shoulder surgeons.

Clinical relevance: Validated procedural metrics combined with the use of a cadaveric shoulder can be used to accurately assess the performance of an ARCR.

MeSH terms

Arthroscopy / methods*
Cadaver
Female
Humans
Male
Middle Aged
Reproducibility of Results
Rotator Cuff / surgery*
Rotator Cuff Injuries / surgery*
Shoulder Joint / surgery*
Video Recording