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Hwang JT, Kim YB, Cho MS, Seo SJ, Hong MS. Combination of Superior and Posterior Capsular Release Versus Superior Capsular Release Alone in Arthroscopic Repair of Large-to-Massive Rotator Cuff Tears. Orthop J Sports Med 2024; 12:23259671241235916. [PMID: 38486808 PMCID: PMC10938623 DOI: 10.1177/23259671241235916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/06/2023] [Indexed: 03/17/2024] Open
Abstract
Background Superior capsular release has been used to reduce tendon tension, especially in arthroscopic repair of large-to-massive rotator cuff tears. Some clinicians have used a more extensive release of capsules in arthroscopic cuff repair for adequate reduction of torn tendons to footprints. Purpose To explore the effects of additional posterior capsular release for superior capsular release in arthroscopic repair of large-to-massive rotator cuff tears. Study Design Cohort study; Level of evidence, 3. Methods We compared 26 shoulders that underwent superior and posterior capsular release (group S&P) with 26 shoulders that underwent superior capsular release alone (group S) in arthroscopic repair of large-to-massive rotator cuff tears between January 23, 2013 and December 2, 2015. The visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and range of motion (ROM) and muscle power were checked preoperatively and at 2 years postoperatively. Follow-up ultrasound was checked at 2 years postoperatively. Results In both groups, the overall mean functional outcomes improved from preoperatively to postoperatively. Patients in group S&P showed more pre- to postoperative improvement than patients in group S with regard to internal rotation ROM (mean difference, 30.0° vs 20.6°; P < .001) and internal rotation power (3.4 vs 1.8 kgf; P = .001). Patients in group S had a higher retear rate on the follow-up ultrasound than patients in group S&P, but this difference did not reach statistical significance (23.1% vs 11.5%, respectively; P = .465). Conclusion In the current study, patients who underwent superior and posterior capsular release in arthroscopic repair of large-to-massive rotator cuff tears had greater postoperative improvement in internal rotation ROM and power compared with patients who underwent superior capsular release alone.
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Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Yong-Been Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Min-Soo Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Su-Jung Seo
- Department of Orthopedic Surgery, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Myung Sun Hong
- Department of Radiology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon-si, Gangwon-do, Republic of Korea
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Song W, Guo X, Wang X, Yu J, Jiang W, Wei C, Zhao Y. A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial. Trials 2023; 24:765. [PMID: 38012777 PMCID: PMC10683184 DOI: 10.1186/s13063-023-07810-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Frozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI. METHODS A parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors. DISCUSSION This study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury. TRIAL REGISTRATION Chictr.org.cn ChiCTR2200067122 . Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.
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Affiliation(s)
- Wuwei Song
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoyu Guo
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Wang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Jiacheng Yu
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenyu Jiang
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wei
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuhao Zhao
- Shi's Center of Orthopedics and Traumatology (Institute of Traumatology, Shuguang Hospital), Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Liu J, Wang W, Wang Z, Wu Q, Zhu Y, Wu W, Zhou Q. The Association between Dietary Habits and Rapid Postoperative Recovery of Rotator Cuff Repair. Nutrients 2023; 15:4587. [PMID: 37960241 PMCID: PMC10648498 DOI: 10.3390/nu15214587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Some nutritional factors have been suggested to improve postoperative outcomes in rotator cuff (RC) repair, but dietary effects on the recovery speed after the surgery remain undefined. To investigate the potential roles of dietary habits in this context, we analyzed the 12-month follow-up data of 55 patients with RC repair and found that these patients could be categorized into a rapid recovery group (n = 35) and slow recovery group (n = 20) according to their postoperative recovery patterns. Group-based logistic analysis revealed that habitual intakes of meat (OR = 1.84, 95%CI, 1.22-2.76, p = 0.003), fruits (OR = 2.33, 95%CI, 1.26-5.67, p = 0.01), and wheat-flour foods (OR = 1.62, 95%CI, 1.2-2.25, p = 0.002) were significantly associated with rapid recovery. Moreover, among all intakes of wheat-flour foods, intakes of steamed and boiled flour products were also associated with rapid recovery. Further mediation analysis showed that eosinophilic granulocytes (EOs) significantly mediated the association between rapid RC recovery and the habitual intakes of meat (mediation proportion = 17.5%, P-mediation < 0.0001), fruits (17.9%, p < 0.0001), and wheat-flour foods (11.4%, p < 0.0001). Thus, our study suggests that certain dietary habits play beneficial roles in the context of postoperative recovery for RC repair.
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Affiliation(s)
- Jiaxin Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Wei Wang
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
| | - Zhifeng Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Qingyun Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Yunli Zhu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
| | - Weicheng Wu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, Human Phenome Institute, School of Life Sciences, Fudan University, Shanghai 200438, China; (Z.W.); (Q.W.)
- Rugao Research Institute of Longevity and Aging, Fudan University, Rugao 226500, China
| | - Qi Zhou
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai 200003, China; (J.L.); (W.W.); (Y.Z.)
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Yao L, Li Y, Li T, Pang L, Li J, Tang X. One-stage rotator cuff repair in stiff shoulders shows comparable range of motion, clinical outcome and retear rates to non-stiff shoulders: a systematic review. J Orthop Surg Res 2023; 18:613. [PMID: 37608386 PMCID: PMC10464261 DOI: 10.1186/s13018-023-04104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND One-stage treatment involving rotator cuff repair and shoulder capsule release is mainly used to treat patients with rotator cuff tears (RCTs) and concomitant shoulder stiffness. Despite the increasing attention to the efficacy and safety of one-stage treatment, controversy still remains. Therefore, this systematic review aims to summarize the indications, operation procedure and rehabilitation protocol, and compare the range of motions (ROMs), functional outcomes and retear rates of one-stage treatment for RCTs in stiff shoulders and non-stiff shoulders. METHODS Multiple databases (PubMed, the Cochrane Library, Embase and MEDLINE) were searched for studies that investigated outcomes after one-stage treatment for RCTs concomitant with shoulder stiffness compared with rotator cuff repair for RCTs alone, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Descriptive statistics, including range of motion, patient-reported outcome and retear rate, are presented without meta-analysis due to the heterogeneity and low levels of evidence. RESULTS A total of 9 cohort studies were included, with 305 patients treated with one-stage treatment involving rotator cuff repair and simultaneous shoulder capsular release and 1059 patients treated with rotator cuff repair alone. Patients in both groups had significant symptom improvement and functional recovery after the one-stage treatment for the stiffness group and standard repair for the non-stiffness group, and most patients could return to normal life and work within 6 months after the operation. The retear rate in the one-stage treatment group was not higher than that in the rotator cuff repair group. No statistically significant differences between the two groups were observed in terms of range of motion and patient-reported outcomes in the vast majority of studies at the final follow-up, including the visual analog scale for pain, the Constant score, the American Shoulder and Elbow Surgeons score, the University of California Los Angeles Shoulder Score, the Oxford shoulder score and the Simple Shoulder Test. CONCLUSION One-stage treatment for RCTs in stiff shoulders provides comparable ROM and patient-reported clinical outcomes as rotator cuff repair for non-stiff RCTs. In addition, the rate of postoperative retear in stiff shoulder treated with one-stage treatment was not higher than in non-stiff shoulders.
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Affiliation(s)
- Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Cognetti DJ, Hartzler RU, Burkhart SS. Arthroscopic Rotator Cuff Repair, Manipulation Under Anesthesia, and Capsular Release for Concurrent Rotator Cuff Tear and Adhesive Capsulitis Maintain Improvements in Outcomes and Range of Motion at Minimum 5-Year Follow-Up. Arthrosc Sports Med Rehabil 2023; 5:e597-e605. [PMID: 37388863 PMCID: PMC10300550 DOI: 10.1016/j.asmr.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To characterize the outcomes and range of motion at a minimum 5-year follow-up in patients undergoing arthroscopic rotator cuff repair (ARCR) with simultaneous manipulation under anesthesia (MUA) and capsular release (CR) for concurrent RC and adhesive capsulitis and to compare active range of motion of the operative and nonoperative shoulder. Methods Patients undergoing ARCR with MUA and CR by a single surgeon were retrospectively reviewed and prospectively evaluated at a minimum of 5 years postoperatively. Standardized surveys, examinations, and patient-reported outcomes were recorded pre- and postoperatively. Outcome measures included range of motion, American Shoulder and Elbow Surgeon Score (ASES), visual analog score (VAS) for pain, Simple Shoulder Test (SST), subjective shoulder value (SSV), functional level, and satisfaction. Results Fourteen consecutive patients were evaluated at 7.5 ± 1.6 years' follow-up. At final follow-up, the affected shoulder had substantial improvements in ASES (P < .001), VAS (P < .001), SST (P = .001), and SSV (P < .001), with similar ASES, VAS, SST, and SSV compared with the contralateral side. Range of motion was also similar to the contralateral side at final follow-up for forward elevation and internal rotation, but external rotation was noted to be 10.77 ± 17.06° (95% confidence interval 0.46-21.08, P = .042) more limited. Two patients (14%) underwent revision MUA and CR for stiffness at 6 months and 12 months' postoperatively. Conclusions This study highlights significantly improved and maintained patient-reported outcomes and range of motion at minimum 5-year follow-up in patients undergoing concomitant ARCR, MUA, and CR. These results provide further evidence that preoperative stiffness in the setting of rotator cuff tear can be managed concurrently; however, patients may remain at an increased risk for recurrent stiffness and external rotation loss. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Robert U. Hartzler
- The San Antonio Orthopedic Group, San Antonio, Texas, U.S.A
- Burkhart Research Institute for Orthopedics, San Antonio, Texas, U.S.A
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Uno T, Mura N, Yuki I, Takagi M. Shoulder activity of the contralateral shoulder as a prognostic factor in patients with arthroscopic rotator cuff repair. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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7
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Barnes RH, Paterno AV, Lin FC, Zhang J, Berkoff D, Creighton RA. Glenohumeral Hydrodistension for Postoperative Stiffness After Arthroscopic Primary Rotator Cuff Repair. Orthop J Sports Med 2022; 10:23259671221104505. [PMID: 35722178 PMCID: PMC9201319 DOI: 10.1177/23259671221104505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/31/2022] [Indexed: 01/16/2023] Open
Abstract
Background: Postoperative stiffness is a known complication after rotator cuff repair
(RCR). Glenohumeral hydrodistension (GH) has been a treatment modality for
shoulder pathology but has not been used to treat postoperative stiffness
after RCR. Purpose/Hypothesis: The purpose of this study was to identify the risk factors for postoperative
stiffness after RCR and review outcomes after treatment with GH. Our
hypotheses were that stiffness would be associated with diabetes and
hyperlipidemia and correlated with the tendons involved and that patients
with stiffness who underwent GH would have significant improvement in range
of motion (ROM). Study Design: Case series; Level of evidence, 4. Methods: Included were 388 shoulders of patients who underwent primary RCR by a single
surgeon between 2015 and 2019. Shoulders with revision RCRs were excluded.
Patient characteristics, medical comorbidities, and perioperative details
were collected. A total of 40 shoulders with postoperative stiffness (10.3%)
received GH injectate of a 21-mL mixture (15 mL of sterile water, 5 mL of
0.5% ropivacaine, and 1 mL of triamcinolone [10 mg/mL]). The primary outcome
measure was ROM in forward flexion, internal rotation, external rotation,
and abduction. Statistical tests were performed using analysis of
variance. Results: Patients with diabetes had significantly decreased internal rotation at final
follow-up after RCR as compared with patients without diabetes. GH to treat
stiffness was performed most commonly between 1 and 4 months after RCR
(60%), and patients who received GH saw statistically significant
improvements in forward flexion, external rotation, and abduction after the
procedure. Patients with hyperlipidemia had the most benefit after GH. Among
those undergoing concomitant procedures, significantly more patients who had
open subpectoral biceps tenodesis underwent GH. Patients who underwent
subscapularis repair or concomitant subacromial decompression had
significant improvement in ROM after GH. Only 1 patient who received GH
underwent secondary surgery for resistant postoperative stiffness. Conclusion: Patients with diabetes had increased stiffness. Patients with a history of
hyperlipidemia or concomitant open subpectoral biceps tenodesis were more
likely to undergo GH for postoperative stiffness. Patients who underwent
subscapularis repair demonstrated the most improvement in ROM after GH.
After primary RCR, GH can increase ROM and is a useful adjunct for patients
with stiffness to limit secondary surgery.
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Affiliation(s)
- Ryan H Barnes
- Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Anthony V Paterno
- Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jingru Zhang
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Berkoff
- Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - R Alexander Creighton
- Department of Orthopaedics, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
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Uno T, Mura N, Yuki I, Oishi R, Takagi M. Factors correlated with the optimal tension for arthroscopic rotator cuff repair using Grasper Tensioning Attachment. J Shoulder Elbow Surg 2022; 31:e213-e222. [PMID: 34687919 DOI: 10.1016/j.jse.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/17/2021] [Accepted: 10/06/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the optimal tension in arthroscopic rotator cuff repair (ARCR). This study aimed to identify preoperative, intraoperative, and postoperative factors that correlate with the tension in ARCR and to determine the optimal intraoperative tension using Grasper Tensioning Attachment, a tension meter attached to the common arthroscopic surgical grasper. METHODS This study included 63 patients with a mean age at surgery of 65.3 years (range, 45-83 years) who underwent ARCR. The mean follow-up period was 24.1 months (range, 24-28 months). We investigated the patients' demographic data, Japanese Orthopaedic Association score, DeOrio and Cofield classification, and Goutallier stage of the supraspinatus and infraspinatus muscles. We also evaluated cuff integrity based on the Sugaya classification via magnetic resonance imaging. The free edge of the torn retracted tendon was grasped, and the passive tension to the footprint was then measured with Grasper Tensioning Attachment with the arm at the side. The anteroposterior (AP) and mediolateral (ML) diameters were also measured. RESULTS The preoperative Goutallier stage of the supraspinatus muscle was stage 0 in 7 cases, stage 1 in 34, stage 2 in 20, and stage 3 in 2. The mean intraoperative rotator repair tension was 10.0 ± 2.5 N (range, 7.5-17 N). The mean AP diameter of the rotator cuff tear was 22 ± 10 mm (range, 8-50 mm), and the mean ML diameter was 24 ± 10 mm (range, 10-50 mm). Age, DeOrio and Cofield classification, Goutallier stage, AP diameter, and ML diameter correlated with rotator repair tension. The rotator repair tension in Sugaya classification type III or IV cases (n = 12, 11.4 ± 2.4 N) was significantly larger than that in type I or II cases (n = 51, 9.7 ± 2.4 N; P = .03). Tension ≥ 10 N as a cutoff value from receiver operating characteristic curve analysis was a risk factor for poor cuff integrity (95% confidence interval, 0.53-0.88). CONCLUSIONS Rotator repair tension ≥ 10 N was a risk factor for poor cuff integrity. Thus, care should be taken when performing intraoperative procedures and administering postoperative regimens.
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Affiliation(s)
- Tomohiro Uno
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan.
| | - Nariyuki Mura
- Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan; Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Issei Yuki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan
| | - Ryuta Oishi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan; Department of Orthopaedic Surgery, Yoshioka Hospital, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:2220-2227. [PMID: 32347347 DOI: 10.1007/s00167-020-06019-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE The purposes of this study were to (1) evaluate changes in recovery patterns [i.e., clinical outcomes, range of motion (ROM)] in the first 12 months following surgery, (2) identify potential prognostic factors of early clinical outcomes after rotator cuff repair (RCR). METHODS The study cohort included 344 consecutive patients treated with RCR. Data were collected prospectively and included pre- and perioperative variables. Univariate and multivariate linear regression analyses for various parameters including demographics, pre- and perioperative variables were used to predict shoulder function at 12-month follow-up, as measured by clinical outcomes and ROM. RESULTS Significant improvement in all clinical scores and ROM were noted during serial follow-ups after RCR (all p < 0.001). Multivariate analysis revealed that female sex, older age, more anchors, diabetes mellitus, and preoperative stiffness were independently associated with worse shoulder function 3 months after RCR. Including the 3 months factors, heavy labor, use of the suture-bridge technique, and large tears were also independently associated with worse outcomes 6 months after surgery. Heavy labor, suture-bridge technique, diabetes mellitus, and preoperative stiffness were associated with significantly worse functional outcomes at 12 months after surgery (all p < 0.05). CONCLUSION Functional recovery based on clinical outcomes (i.e., UCLA, ASES scores) showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after RCR. Female sex, diabetes mellitus, preoperative stiffness, a larger number of anchors, suture bridge technique, heavy labor, old age and, larger tears were prognostic factors of poor clinical results or ROM in the short-term follow-up intervals. Knowledge of these prognostic factors may lead to improved insight for physicians to predict the pattern of the recovery and patient expectations accordingly. LEVEL OF EVIDENCE III, A cohort study.
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10
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Hwang JT. Arthroscopic capsular release versus manipulation under anesthesia for primary frozen shoulder. Clin Shoulder Elb 2020; 23:167-168. [PMID: 33330253 PMCID: PMC7726360 DOI: 10.5397/cise.2020.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jung-Taek Hwang
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Korea
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11
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Millican CR, Lam PH, Murrell GAC. Shoulder stiffness after rotator cuff repair: the fate of stiff shoulders up to 9 years after rotator cuff repair. J Shoulder Elbow Surg 2020; 29:1323-1331. [PMID: 32088077 DOI: 10.1016/j.jse.2019.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/03/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Stiffness and retear are 2 common complications of rotator cuff repair. McNamara et al found that postoperative stiffness was associated with lower retear rates at 6 months. This study aimed to determine if stiffness after rotator cuff repair protects the individual from retear up to 9 years after surgery. MATERIALS AND METHODS Two groups of patients, 69 with stiff and 63 with nonstiff shoulder, who underwent arthroscopic rotator cuff repair were created based on external rotation measurements at 6 weeks postoperatively. Patients had regular follow-up assessments at 6, 12, and 24 weeks and were instructed to return for a follow-up at least 2 years after surgery. Patients were assessed for range of motion, shoulder function, strength, and rotator cuff integrity using ultrasound. RESULTS For patients with postoperative stiffness at 6 weeks, the retear rate at 6 months was 3%, whereas the rate for nonstiff patients was 19% (P = .004). This protective effect of postoperative stiffness persisted up to 9 years after surgery (P = .002). Postoperative stiffness resolved by 5 years after surgery for all measurements except external rotation (50° vs. 61°) (P = .006). Patients with postoperative stiffness had continued improvements in abduction (P < .001), internal rotation (P = .020), and all patient-ranked measurements from the 6-month follow-up to 5 years after surgery. Patients with stiff shoulder had greater overall satisfaction by the final follow-up (P = .028). CONCLUSIONS In patients experiencing stiffness after rotator cuff surgery, the repair is less likely to fail at 6 months. Although the stiffness generally resolves by 5 years, this protective effect still persists at 9 years after surgery.
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Affiliation(s)
- Christopher R Millican
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, NSW, Australia.
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12
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Glenohumeral synovitis score predicts early shoulder stiffness following arthroscopic rotator cuff repair. J Orthop 2020; 22:17-21. [PMID: 32273668 DOI: 10.1016/j.jor.2020.03.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 11/20/2022] Open
Abstract
Background This study was conducted to determine if there is an association between an intraoperative glenohumeral synovitis score (GHSS) and postoperative shoulder stiffness in patients undergoing arthroscopic rotator cuff repair (ARCR). Methods Intraoperative GHSS was collected retrospectively from standardized arthroscopic images on consecutive patients undergoing primary ARCR. Range of motion was collected preoperatively and postoperatively at 3 and 6 months. Results 290 consecutive patients underwent primary ARCR. At three-months follow-up, 32 (11.0%) patients had glenohumeral stiffness. Patients with stiffness had significantly higher mean GHSS. Conclusion Higher intraoperative GHSS was associated with early postoperative shoulder stiffness at three-months after ARCR.
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MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness. Int J Mol Sci 2019; 20:ijms20225742. [PMID: 31731750 PMCID: PMC6888443 DOI: 10.3390/ijms20225742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 02/08/2023] Open
Abstract
Rotator cuff lesion with shoulder stiffness is a major cause of shoulder pain and motionlessness. Subacromial bursa fibrosis is a prominent pathological feature of the shoulder disorder. MicroRNA-29a (miR-29a) regulates fibrosis in various tissues; however, the miR-29a action to subacromial bursa fibrosis remains elusive. Here, we reveal that subacromial synovium in patients with rotator cuff tear with shoulder stiffness showed severe fibrosis, hypertrophy, and hyperangiogenesis histopathology along with significant increases in fibrotic matrices collagen (COL) 1A1, 3A1, and 4A1 and inflammatory cytokines, whereas miR-29a expression was downregulated. Supraspinatus and infraspinatus tenotomy-injured shoulders in transgenic mice overexpressing miR-29a showed mild swelling, vascularization, fibrosis, and regular gait profiles as compared to severe rotator cuff damage in wild-type mice. Treatment with miR-29a precursor compromised COL3A1 production and hypervascularization in injured shoulders. In vitro, gain of miR-29a function attenuated COL3A1 expression through binding to the 3’-untranslated region (3′-UTR) of COL3A1 in inflamed tenocytes, whereas silencing miR-29a increased the matrix expression. Taken together, miR-29a loss is correlated with subacromial bursa inflammation and fibrosis in rotator cuff tear with shoulder stiffness. miR-29a repressed subacromial bursa fibrosis through directly targeting COL3A1 mRNA, improving rotator cuff integrity and shoulder function. Collective analysis offers a new insight into the molecular mechanism underlying rotator cuff tear with shoulder stiffness. This study also highlights the remedial potential of miR-29a precursor for alleviating the shoulder disorder.
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Zhang K, de Sa D, Kanakamedala A, Sheean AJ, Vyas D. Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes. Arthroscopy 2019; 35:979-993. [PMID: 30733032 DOI: 10.1016/j.arthro.2018.10.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection. CONCLUSIONS The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation. LEVEL OF EVIDENCE Level V, systematic review of Level II, III, IV, and V studies.
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Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A..
| | | | - Andrew J Sheean
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Dharmesh Vyas
- UPMC Lemieux Sports Complex, Cranberry, Pennsylvania, U.S.A
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15
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Editorial Commentary: Don't Let Cuff Tears With Adhesive Capsulitis Give You the Cold Shoulder. Arthroscopy 2019; 35:994-995. [PMID: 30827447 DOI: 10.1016/j.arthro.2018.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
Despite vastly different rehabilitation goals, adhesive capsulitis and a rotator cuff tear of the shoulder can be treated concomitantly with good outcomes. In the face of adhesive capsulitis, rotator cuff tears can be safely repaired with manipulation under anesthesia and/or capsular release without a substantial increase in complication rates compared with patients undergoing rotator cuff repair alone. Adhesive capsulitis pathology causes the cuff to heal rapidly, and we recommend aggressive passive range of motion as part of a traditional but accelerated rehabilitation that can be monitored and thus adjusted on a case-by-case basis.
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Nakamura Y, Gotoh M, Mitsui Y, Nakamura H, Ohzono H, Okawa T, Shiba N. Prognostic factors affecting clinical outcomes after arthroscopic rotator cuff repair: importance of functional recovery by 3 months after surgery. J Orthop Surg Res 2018; 13:310. [PMID: 30518384 PMCID: PMC6282280 DOI: 10.1186/s13018-018-1014-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To examine important factors that affect clinical outcomes following arthroscopic rotator cuff repair (ARCR). METHODS Among 163 patients who underwent ARCR, we included 71 shoulders in 71 patients whose progress was monitored for > 2 years, postoperatively. We divided the patients into groups A (scores ≥ 83 points, 59 patients) and B (scores < 83 points, 12 patients) using the Japanese Orthopedic Association (JOA) score at 24 months. We then conducted univariate and multivariate analyses of pre- and postoperative (2 and 3 months, respectively) factors. RESULTS The mean JOA score for all patients significantly improved from 63.7 ± 11.5 points preoperatively to 90.3 ± 9.6 points at 24 months postoperatively (P < 0.05). However, there were no significant between-group differences in the preoperative scores. In addition, there were no significant differences in the postoperative re-tear rate. Univariate analysis revealed that the range of motion (preoperative abduction and postoperative elevation, abduction, internal rotation, and external rotation), muscle strength (external rotation 3 months postoperatively), postoperative pain level [visual analog scale (VAS) maximum score, 10 points], partial repair, Cofield classification, and preoperative width were significant factors (P < 0.05 for all factors). Multivariate and receiver operating characteristic curve analyses showed that VAS at 2 months postoperatively and elevation at 3 months postoperatively were significant factors. CONCLUSIONS To obtain a JOA score of ≥ 83 points at 24 months postoperatively, following ARCR, a postoperative VAS of < 5 points at 2 months and postoperative elevation of ≥ 110° at 3 months should be achieved.
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Affiliation(s)
- Yosuke Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan.
| | - Yasuhiro Mitsui
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
| | - Hidehiro Nakamura
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
| | - Hiroki Ohzono
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
| | - Takahiro Okawa
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, Fukuoka, 839-0863, Japan
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17
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Abstract
Shoulder stiffness affects a diverse population of patients suffering a decrease in function and shoulder pain. Arthroscopic management of this debilitating spectrum of pathology is a safe and effective course of action in cases recalcitrant to nonoperative therapy. Arthroscopic management of the stiff shoulder has been reported to be effective in the treatment of stiffness due to adhesive capsulitis, birth palsy, stiffness in the setting of rotator cuff tears, and osteoarthritis in the posttraumatic patient, in the postoperative patient, and in the throwing athlete. Arthroscopic management is most effective in treating the stiff shoulder in the setting of adhesive capsulitis recalcitrant to nonoperative therapy or posttraumatic stiffness. Results are more guarded in the treatment of postoperative stiffness. Excessive force and trauma to the shoulder, including fracture of the humerus, can be avoided with a 360[degrees] capsular release for shoulder stiffness rather than manipulation under anesthesia.
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Affiliation(s)
- Vasili Karas
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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18
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Kim IB, Jung DW. A Rotator Cuff Tear Concomitant With Shoulder Stiffness Is Associated With a Lower Retear Rate After 1-Stage Arthroscopic Surgery. Am J Sports Med 2018; 46:1909-1918. [PMID: 29757693 DOI: 10.1177/0363546518768813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have reported on the radiological characteristics and repair integrity of coexistent rotator cuff tears (RCTs) and shoulder stiffness after simultaneous arthroscopic rotator cuff repair and capsular release. PURPOSE To evaluate the radiological characteristics and repair integrity of 1-stage arthroscopic surgery of RCTs concomitant with shoulder stiffness. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Among patients who underwent arthroscopic repair of full-thickness RCTs, the stiff group underwent simultaneous capsular release for shoulder stiffness, and the nonstiff group had no stiffness. Symptom duration, prevalence of diabetes, tear size, tendon involvement (type 1, supraspinatus; type 2, supraspinatus and subscapularis; and type 3, supraspinatus and infraspinatus; type 4, supraspinatus, subscapularis, and infraspinatus), and fatty infiltration (Goutallier stages 0-4) were evaluated. A retear was appraised using magnetic resonance imaging, and clinical outcomes were assessed using range of motion, the Korean Shoulder Scoring System (KSS), and the University of California, Los Angeles (UCLA) shoulder score. RESULTS The stiff group showed a significantly lower retear rate (1/39, 2.6%) than the nonstiff group (47/320, 14.7%) ( P = .043). There were significant differences in symptom duration (7.4 ± 6.6 vs 15.0 ± 23.7 months, respectively; P < .001), mediolateral tear size (18.9 ± 8.9 vs 24.1 ± 12.0 mm, respectively; P = .002), tendon involvement (94.9%, 5.1%, 0.0%, and 0.0% vs 85.3%, 6.9%, 7.8%, and 0.0%, respectively; P = .048), and fatty infiltration of the subscapularis (66.7%, 33.3%, 0.0%, 0.0%, and 0.0% vs 31.9%, 61.3%, 5.6%, 1.3%, and 0.0%, respectively; P < .001) and teres minor (74.4%, 20.5%, 5.1%, 0.0%, and 0.0% vs 47.2%, 48.8%, 3.8%, 0.0%, and 0.3%, respectively; P = .007) between the stiff and nonstiff groups. Preoperatively, the stiff group showed significantly worse forward flexion (95.9° ± 23.6° vs 147.7° ± 4.2°, respectively; P < .001), external rotation (17.4° ± 10.1° vs 51.6° ± 12.1°, respectively; P < .001), and internal rotation (L5 vs L2, respectively; P < .001) and lower KSS (52.1 ± 13.8 vs 66.3 ± 13.5, respectively; P < .001) and UCLA scores (18.7 ± 4.8 vs 22.5 ± 4.5, respectively; P < .001) than the nonstiff group. However, these differences became insignificant from 3 months postoperatively for forward flexion ( P > .05) and KSS ( P > .05) and UCLA scores ( P > .05), from 1 year postoperatively for external rotation ( P > .05), and at the last follow-up for internal rotation ( P > .05). A multiple logistic regression analysis revealed that only mediolateral tear size (odds ratio, 1.043; P = .014) and type 2 tendon involvement (odds ratio, 4.493; P = .003) were independent predictors of a retear. CONCLUSION RCTs concomitant with shoulder stiffness showed a smaller mediolateral tear size, anterosuperior tendon involvement, and less severe fatty infiltration preoperatively and better repair integrity postoperatively than RCTs without stiffness. Furthermore, the clinical outcomes and range of motion at final follow-up were similar between the 2 groups.
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Affiliation(s)
- In-Bo Kim
- Busan Bumin Hospital, Busan, Republic of Korea
| | - Dong-Wook Jung
- Investigation performed at Busan Bumin Hospital, Busan, Republic of Korea
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Jeong HJ, Rhee SM, Oh JH. Postoperative New-Onset Pseudoparalysis: A Retrospective Analysis of 430 Consecutive Arthroscopic Repairs for Large to Massive Rotator Cuff Tears. Am J Sports Med 2018; 46:1701-1710. [PMID: 29648474 DOI: 10.1177/0363546518765756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The authors have sometimes encountered postoperative new-onset pseudoparalysis (PONP) after arthroscopic repair for large to massive rotator cuff tear (ARCR). As there are insufficient data regarding PONP, the authors aimed to determine whether such a condition is characterized by obvious risk factors, as well as to assess the conditions under which it can be reversed. PURPOSE To evaluate the predictors of PONP development after ARCR and its reversal and to integrate these predictors into a scoring system that can be applied in clinical practice. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS The authors retrospectively analyzed 430 consecutive ARCRs performed between March 2010 and May 2016. Patients were stratified according to the occurrence of PONP. To determine the risk factors of PONP, the authors compared the PONP and control groups (patients who did not experience PONP) in terms of demographic, clinical, and operative characteristics. Results were expressed in terms of odds ratios (ORs). RESULTS The incidence of PONP was 6.0% (26 of 430). Predictors of PONP included torn subscapularis (OR, 7.875; 95% CI, 1.780-34.956; P = .007), ≥30-mm retraction of the torn supraspinatus (OR, 4.657; 95% CI, 1.537-14.203; P = .007), age ≥65 years (OR, 3.865; 95% CI, 1.465-10.040; P = .006), and preoperative stiffness (OR, 2.954; 95% CI, 1.212-7.159; P = .017). The reversal rate of PONP was 65.4% (17 of 26), and the mean time to PONP reversal was 10 months. The occurrence and reversal of PONP were not related to retear. Fatty infiltration of the supraspinatus lower than Goutallier grade 3 was the sole predictor of reversal (OR, 22.000; 95% CI, 1.857-260.648; P = .014). CONCLUSION Although the incidence of PONP after ARCR was low (6.0%), the risk of PONP was higher in patients with a torn subscapularis, larger supraspinatus tear size, older age, and preoperative stiffness. The mean time from PONP onset to reversal was 10 months, and PONP reversal was affected solely by fatty infiltration of the supraspinatus. Therefore, surgeons should consider the risk for PONP and attempt to identify high-risk patients before rotator cuff repair.
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Affiliation(s)
- Hyeon Jang Jeong
- Department of Orthopedic Surgery, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
| | - Sung Min Rhee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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20
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Tang X, Huang F, Chen G, Li Q, Fu W, Li J. [Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1-6. [PMID: 29806356 DOI: 10.7507/1002-1892.201708073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To investigate effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness. Methods A retrospectively study was performed on the data of 15 patients with rotator cuff tear combined with shoulder stiffness (stiff group) and 24 patients without stiffness (non-stiff group) between January 2014 and December 2015. The patients in the stiff group underwent arthroscopic rotator cuff repair with manipulation release and arthroscopic debridement while the patients in the non-stiff group only received arthroscopic rotator cuff repair. The patients in the stiff group were older than the patients in the non-stiff group, showing significant difference ( P<0.05). There was no significant difference in gender, type of rotator cuff tear, side of rotator cuff tear, and combined with diabetes between 2 groups ( P>0.05). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were used to evaluate the effectiveness after operation. Results All incisions healed by first intention without any complication after operation. The patients were followed up 13-31 months in the stiff group (mean, 19.2 months) and 13-23 months in the non-stiff group (mean, 20.3 months). There was no significant difference in follow- up time between 2 groups ( t=-0.573, P=0.570). The VAS score in the stiff group was higher than that in the non-stiff group before operation ( t=-2.166, P=0.037); there was no significant difference between 2 groups at 3, 6, 12 months and last follow-up ( P>0.05). The forward flexion and external rotation were significantly lower in the stiff group than those in the non-stiff group before operation and at 3 months after operation ( P<0.05); there was no significant difference between 2 groups at 6, 12 months and last follow-up ( P>0.05). At last follow-up, the internal rotation was beyond L 3 level in 2 groups. The preoperative UCLA score was significant lower in the stiff group than that in the non-stiff group ( P=0.037); but there was no significant difference in UCLA score at last follow-up between 2 groups ( P=0.786). There was no significant difference in pre- and post-operative ASES scores between 2 groups ( P>0.05). Conclusion Satisfactory effectiveness can be achieved in the patients with rotator cuff tear combined with shoulder stiffness after rotator cuff repair with manipulation release and arthroscopic debridement, although the patients with shoulder stiffness had slower postoperative recovery of ROM until 6 months after operation.
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Affiliation(s)
- Xin Tang
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Gang Chen
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Qi Li
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041,
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Classifying glenohumeral synovitis: a novel intraoperative scoring system. J Shoulder Elbow Surg 2017; 26:2047-2053. [PMID: 28747275 DOI: 10.1016/j.jse.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/06/2017] [Accepted: 06/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Synovitis of the shoulder is a common entity that is poorly described. This study aims to create a simple and reliable classification system for glenohumeral synovitis, which would benefit further research related to synovitis and outcomes. METHODS Twenty 30-second shoulder arthroscopy videos were distributed to 19 fellowship-trained orthopedic surgeons. The observers responded with their years in practice, fellowship type, whether synovitis affects outcomes, and whether synovitis affects plans. The surgeons then rated the videos based on the following: color of capsule (pale, pink, or red); villous projections (none, few, or extensive); capillaries in capsule (scattered or hypertrophied); and axillary recess (normal or contracted). Scores ranging from 0 to 6 were assigned. The videos were randomized and redistributed at a later date. Statistical analysis used an intraclass correlation coefficient with a mixed-effects model to calculate variability based on observer. RESULTS Nineteen observers completing the survey twice resulted in 760 videos being scored. There were 12 shoulder surgeons and 7 sports surgeons. Only 4 surgeons believed that synovitis did not affect outcomes, and the remaining 15 believed that it did. The intraclass correlation coefficient showed that 68% of the variation in measured scores was due to variation among patients and only 4% was due to variation among observers. There was no significant variation seen in scores due to surgeon experience, surgeon specialty, or first and second viewing. CONCLUSIONS This interclass observer reliability shoulder synovitis study defined a system with excellent reliability among a range of surgeons with diverse training and experience. In addition, there was excellent reliability for the same surgeon between viewings.
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Chen Y, Chen S, Qiao Y, Ge Y, Li H, Chen J, Hua Y, Li Y. A Long Preoperative Duration of Symptoms Is Associated With Worse Functional Outcomes After 1-Stage Arthroscopic Treatment of Rotator Cuff Tears With Shoulder Stiffness. Am J Sports Med 2017; 45:2336-2344. [PMID: 28534670 DOI: 10.1177/0363546517707202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears with shoulder stiffness remain a difficult issue. Despite the reported satisfactory results of 1-stage surgery, little information is available regarding the factors that affect clinical outcomes. Purpose/Hypothesis: To evaluate the 1-stage arthroscopic treatment of rotator cuff tears with shoulder stiffness and to present the influence of duration of symptoms (DOS) on postoperative functional outcomes. The hypothesis was that a long preoperative DOS is related to worse functional outcomes. HYPOTHESIS A long preoperative DOS is related to worse functional outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A cohort study was performed with consecutive patients who underwent 1-stage surgery between January 2012 and July 2014. Forty-four patients were enrolled in the long DOS group (DOS ≥6 months or LDOS), and 38 were enrolled in the short DOS group (DOS <6 months or SDOS). There were no significant differences in the other variables between the groups. The patients were followed for a mean of 33.8 months, and the functional and radiographic outcomes were compared. RESULTS Both groups achieved apparent functional postoperative improvements in terms of range of motion, pain, strength, and functional scores ( P < .001 for all). Despite the overall improvements, the patients in the SDOS group had significantly better outcomes according to all functional instruments. The mean postoperative abduction and external rotation at the side in the SDOS group were higher than in the LDOS group (abduction: 162.2° vs 152.8°, respectively [ P = .002]; external rotation: 64.7° vs 56.9°, respectively [ P = .004]). The mean postoperative functional scores in the SDOS group were all higher than in the LDOS group (American Shoulder and Elbow Surgeons [ASES] score: 91.1 vs 81.9, respectively; Constant-Murley score: 76.9 vs 71.8, respectively; Fudan University Shoulder Score [FUSS], 90.6 vs 81.1, respectively), and the mean postoperative visual analog scale (VAS) score for pain in the SDOS group was lower (0.7 vs 1.8, respectively) ( P < .001 for all). The difference in the retear rates was not significant, with 7 retears in the SDOS group and 4 in the LDOS group ( P = .216). CONCLUSION One-stage surgery effectively achieved overall improvements. A preoperative DOS of ≥6 months led to poorer functional outcomes, which suggests that surgeons should propose a surgical treatment for this condition before symptoms persist for 6 months.
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Affiliation(s)
- Yuzhou Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Qiao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunshen Ge
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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23
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Lu Z, Wang J, Xu B, You W, Wang J. [Effectiveness of arthroscopic capsular release to treat primary severe frozen shoulder through trans cuff portal]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:773-777. [PMID: 29798518 DOI: 10.7507/1002-1892.201702012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To assess the effectiveness of arthroscopic capsular release to treat primary severe frozen shoulder through trans cuff portal. Methods Between June 2012 and January 2015, 28 patients with primary severe frozen shoulder were enrolled in the study. There were 8 males and 20 females with an average age of 57 years (range, 42-81 years). The left shoulder was involved in 16 cases and the right one in 12 cases. The mean disease duration was 11 months (range, 7-21 months). Six patients had diabetes. All patients underwent arthroscopic capsular release by trans cuff portal. The range of motion (ROM) of the shoulder were measured at preoperation and at 6 weeks and 24 months after operation; the scores of American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) were used to evaluate the shoulder function and pain. Results Primary healing of incision was obtained, and no complications of infection, shoulder instability, and nerve injury were found. All patients were followed up 24 months. Pain of the shoulder was obviously relieved; VAS score was significantly lower at 6 weeks and 24 months after operation than preoperation ( P<0.05), and at 24 months than 6 weeks ( P<0.05). ROM of the shoulder and ASES score at 6 weeks and 24 months after operation were significantly increased when compared with preoperative ones ( P<0.05); significant difference was found in ROM of forward flexion and external rotation and the ASES score between at 6 weeks and 24 months ( P<0.05). And internal rotation in-creased from trochanter (9 cases), hip (6 cases), sacrum (7 cases), and L 4 vertebral level (6 cases) before operation to the T 12-T 6 vertebral level at 6 weeks and 24 months after operation, which were close to normal side. Conclusion Arthroscopic capsular release through trans cuff portal is an effective and safe management for primary severe frozen shoulder.
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Affiliation(s)
- Zhenfei Lu
- Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Wuxi Jiangsu, 214000, P.R.China
| | - Jianhua Wang
- Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200092, P.R.China
| | - Bing Xu
- Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Wuxi Jiangsu, 214000, P.R.China
| | - Weijia You
- Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Wuxi Jiangsu, 214000, P.R.China
| | - Jianwei Wang
- Department of Orthopedics, Wuxi Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Wuxi Jiangsu, 214000,
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Frequency of Shoulder Corticosteroid Injections for Pain and Stiffness After Shoulder Surgery and Their Potential to Enhance Outcomes with Physiotherapy: A Retrospective Study. Pain Ther 2017; 6:45-60. [PMID: 28185130 PMCID: PMC5447542 DOI: 10.1007/s40122-017-0065-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Indexed: 11/03/2022] Open
Abstract
Introduction What is the rate of injecting patients with shoulder corticosteroid injections to alleviate excessive stiffness and pain within 6 months after shoulder surgery? Methods Retrospective 10-year review of a shoulder surgeon’s practice. Participants included 754 patients who had 945 non-arthroplasty shoulder surgeries. Outcome measures included the rate of injections, diagnoses, patient characteristics, and efficacy via questionnaire. Results Approximately one in five patients received a subacromial and/or glenohumeral corticosteroid injection. Over 95% of patients stated that the injections helped reduce shoulder pain and increased function 6 weeks post-injection. Twenty-two percent of cases (208/945) received glenohumeral and/or subacromial injections. The 208 injected cases had these diagnoses: rotator cuff tear (28% of injected patients), subacromial impingement (20%), glenohumeral instability (16%), subacromial impingement with acromioclavicular osteoarthritis (10%), adhesive capsulitis (7%), SLAP lesion (5%), biceps tendinopathy (3%), glenohumeral instability with subacromial impingement (3%), proximal humerus fracture (2%), calcific tendinitis (2%), and less common conditions (4%). Diagnoses among those with the highest rates of injected patients per diagnosis included: SLAP lesions (40%), calcific tendinitis (40%), adhesive capsulitis (29%), subacromial impingement (28%), proximal humerus fracture (24%), rotator cuff tear (19%), and glenohumeral instability (16%). Significant differences (p < 0.03) were found between patients who did and did not receive injections with respect to age (more likely younger patients with cuff tear) and sex (more likely female with subacromial impingement and instability) but not for diabetes or arthroscopic vs. open procedures. Conclusion This is the first study to establish the rates of postoperative shoulder corticosteroid injections within the first 6 months after various non-arthroplasty shoulder surgeries for patients with high pain/stiffness. These data will be useful for establishing guidelines for using corticosteroid injections along with physiotherapy.
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Rehabilitation Strategies After Rotator Cuff Repair: How to Optimize Outcomes. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2016. [DOI: 10.1097/bte.0000000000000105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cho CH, Kim DH, Lee YK. Serial Comparison of Clinical Outcomes After Arthroscopic Capsular Release for Refractory Frozen Shoulder With and Without Diabetes. Arthroscopy 2016; 32:1515-20. [PMID: 27062011 DOI: 10.1016/j.arthro.2016.01.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/05/2015] [Accepted: 01/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare serial clinical outcomes after arthroscopic treatment of refractory frozen shoulder with and without diabetes. METHODS Seventeen patients with diabetic frozen shoulder (diabetes group) and 20 patients with idiopathic frozen shoulder (idiopathic group) were included. The mean follow-up period was 48.4 ± 15.8 months. Visual analog scale pain score; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and range of motion were evaluated preoperatively; at 3, 6, and 12 months after surgery; and at the final follow-up examination. RESULTS Both groups showed significant improvement in all clinical scores and range of motion during the serial follow-up periods (P < .001). There were no significant differences between the 2 groups in any of the assessed clinical scores, except the mean American Shoulder and Elbow Surgeons score in the diabetes group was significantly lower than that in the idiopathic group at 12 months after surgery (77.7 v 88.8, P = .025). In the diabetes group, mean forward flexion was significantly lower than that in the idiopathic group at 3 months (140.0° v 151.5°, P = .011) and 6 months (152.2° v 161.8°, P = .045) after surgery. Mean external rotation was significantly lower than that in the idiopathic group at 6 months after surgery (43.3° v 55.0°, P = .021). Mean internal rotation was significantly lower than that in the idiopathic group at 6 months (13.7 v 11.7, P = .006) and 12 months (12.2 v 9.9, P = .041) after surgery. There were no significant differences between the 2 groups in any assessed outcomes at the final follow-up examination. CONCLUSIONS These results provide supportive evidence suggesting that the diabetes group had slower postoperative functional recovery until 12 months postoperatively, although arthroscopic capsular release for refractory frozen shoulder with and without diabetes yielded satisfactory clinical outcomes at the final follow-up examination. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea.
| | - Dong-Hu Kim
- Department of Orthopedic Surgery, The Open Hospital, Daegu, Republic of Korea
| | - Young-Kuk Lee
- Department of Orthopedic Surgery, Hanmi Hospital, Daegu, Republic of Korea
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Sekundäre Steife der Schulter. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Giuseffi S, Field LD, Giel TV, Brislin BT, Savoie FH. Arthroscopic Rotator Cuff Repair With Concomitant Capsular Release. Arthrosc Tech 2016; 5:e833-e837. [PMID: 27709045 PMCID: PMC5040237 DOI: 10.1016/j.eats.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 04/19/2016] [Indexed: 02/03/2023] Open
Abstract
Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. Some surgeons recommend staging surgical procedures and delaying rotator cuff repair until shoulder stiffness has resolved. However, this can lead to prolonged recovery times and patient dissatisfaction. We describe a surgical technique that allows for the single-stage arthroscopic management of rotator cuff tears with associated adhesive capsulitis. Arthroscopic capsular release and shoulder manipulation are performed in the same operative setting as arthroscopic rotator cuff repair. We have found that this combined, single-stage arthroscopic approach can effectively treat patients with rotator cuff tears and concomitant shoulder stiffness.
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Affiliation(s)
- Steven Giuseffi
- Black Hills Orthopedic and Spine Center, Rapid City, South Dakota, U.S.A
| | - Larry D. Field
- Department of Orthopaedic Surgery, University of Mississippi School of Medicine, Jackson, Mississippi, U.S.A.,Address correspondence to Larry D. Field, M.D., Department of Orthopaedic Surgery, University of Mississippi School of Medicine, 1325 East Fortification St., Jackson MS 39202, U.S.A.Department of Orthopaedic SurgeryUniversity of Mississippi School of Medicine1325 East Fortification St.JacksonMS 39202U.S.A.
| | | | - Brian T. Brislin
- Orthopaedic Surgery & Rehabilitation, Philadelphia, Pennsylvania, U.S.A
| | - Felix H. Savoie
- Division of Sports Medicine, Tulane Institute of Sports Medicine, New Orleans, Louisiana, U.S.A
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McGrath JP, Lam PH, Tan MTS, Murrell GAC. The effect of concomitant glenohumeral joint capsule release during rotator cuff repair--a comparative study. J Shoulder Elbow Surg 2016; 25:714-22. [PMID: 26826766 DOI: 10.1016/j.jse.2015.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/20/2015] [Accepted: 10/19/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is debate as to whether to operate or to defer surgery on patients with concomitant rotator cuff tear and shoulder stiffness. The purpose of this study was therefore to compare the outcomes in those patients who had both their rotator cuff tear and shoulder stiffness treated with the outcomes of patients who had a rotator cuff repair but no stiffness. METHODS Twenty-five patients formed the stiffness group (receiving a concomitant rotator cuff repair and manipulation under anesthesia ± arthroscopic capsular release for preoperative ipsilateral stiffness), and a chronologically matched group of 170 rotator cuff repair-only patients formed the nonstiffness group. Patients ranked their pain and function scores preoperatively and at 1 week, 6 weeks, 12 weeks, 6 months, and 2 years postoperatively; examiners recorded range of motion, strength, and presence of impingement signs. Repair integrity was determined using ultrasound. RESULTS Patients from both groups had significantly improved clinical outcomes at the 2-year follow-up compared with preoperative values. Range of motion was similar between groups at 2 years for forward flexion, abduction, and external rotation, whereas the nonstiffness group had a superior range of internal rotation (P = .014). Stiffness patients had 0 of 25 (0%) retears at 2 years compared with 34 of 170 (20%) in the nonstiffness group (P = .009). CONCLUSIONS The good outcomes of rotator cuff repair with glenohumeral capsular release disproved our hypothesis and suggest that there is no advantage in delaying repair of a rotator cuff tear to allow stiffness to resolve and that stiffness confers an advantage in terms of repair integrity. LEVEL OF EVIDENCE Level III; Retrospective Cohort Design; Treatment Study.
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Affiliation(s)
- Jordan P McGrath
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - Patrick H Lam
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - Martin T S Tan
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia
| | - George A C Murrell
- The Orthopaedic Research Institute, St. George Hospital, The University of New South Wales, Kogarah, Sydney, NSW, Australia.
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