Sex Is Associated with the Success or Failure of Manipulation Alone for Joint Stiffness Associated with Rotator Cuff Repair

Sub-Acromioclavicular Decompression Increases the Risk of Postoperative Shoulder Stiffness after Arthroscopic Rotator Cuff Repair

OBJECTIVE

The sub-acromioclavicular (SAC) decompression is often performed during arthroscopic rotator cuff repair. However, the impact of SAC decompression on patients with postoperative shoulder stiffness (POSS) are controversial and unclear. This study is aim to evaluate the impact of additional sub-acromioclavicular (SAC) decompression during arthroscopic rotator cuff repair on the postoperative shoulder stiffness (POSS) in patients.

METHODS

This retrospective study examined digital data from patients with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair at a local institution. Patient-reported outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) Score, the University of California-Los Angeles (UCLA) score, and visual analog scale (VAS) scores. Restricted shoulder mobility occurring within 6 months postoperatively, lasting more than 12 weeks, characterized by a passive forward flexion angle of <120° or an external rotation angle of <30°, with or without associated shoulder pain was identified as POSS. Factors affecting POSS were analyzed by binary logistic regression analysis. The patient-reported outcomes scores were analyzed by generalized estimating equations to examine the impact of SAC decompression.

RESULTS

A total of 155 patients met the set criteria and were included in the study. The analysis of binary logistic regression showed that diabetes (p = 0.001) and SAC decompression (p = 0.003) were independent factors for POSS. In the analysis of each follow-up point, only at the 3-month follow-up, the ASES scores (p = 0.003), UCLA scores (p = 0.045), and VAS scores (p = 0.005) showed significant differences between the SAC decompression group and the non-decompression group. For the intergroup comparison, the results showed a significant difference in the ASES scores (β = -4.971, p = 0.008), UCLA scores (β = -1.524, p = 0.019), and VAS scores (β = 0.654, p = 0.010) throughout the study duration between the SAC decompression group and the non-decompression group.

CONCLUSION

The findings of this study suggested that SAC decompression during arthroscopic rotator cuff repair increase the risk of POSS compared with those without the decompression, which indicate surgeons do not perform SAC decompression unless necessary.

Corticosteroid Infiltration to Treat Shoulder Stiffness After Rotator Cuff Repair

Purpose

To investigate whether the preoperative shoulder range of motion (ROM), would increase the risk of postoperative shoulder stiffness, or whether it would be associated with other preoperative patient characteristics.

Methods

The authors retrospectively analysed the 372 shoulders that underwent rotator cuff repair by 4 surgeons, between January 2010 and January 2011. All patients were followed up at 3 and 6 months by 2 independent observers to collect the ROM, including active forward elevation (AFE), passive forward elevation (PFE), and external rotation (ER), as well as subjective shoulder value (SSV).

Results

Of the initial cohort of 372 patients, 10 were lost to follow-up (2.7%), leaving a final cohort of 362 patients available for outcome assessment at a minimum follow-up of 6 months. Of the 362 patients, 281 did not require corticosteroid infiltration, 68 received corticosteroid infiltrations for shoulder stiffness with no apparent cause, and 13 received corticosteroid infiltrations for other reasons. None of the variables were associated with infiltration for shoulder stiffness. Older patients had greater SSV scores (β = 0.3; 95% CI [0.1, 0.6]; P = .015), while both manual and repetitive workers had lower SSV scores (β = -10.7; 95% CI [-15.8, -5.6]; P < .001, and β = -10.2; 95% CI [-15.1, -5.3]; P < .001).

Conclusion

Postoperative SSV was significantly associated with age, as well as manual or repetitive work. Furthermore, postoperative PFE, AFE, and ER were significantly associated with preoperative PFE. Finally, at 3 and 6 months postoperative, patients who required infiltration for shoulder stiffness had significantly lower PFE, AFE, and ER compared to patients who did not require infiltration.

Level of Evidence

IV, Case series.

Effects of Adding Extracorporeal Shockwave Therapy (ESWT) to Platelet-Rich Plasma (PRP) among Patients with Rotator Cuff Partial Tear: A Prospective Randomized Comparative Study

A rotator cuff tear is a prevalent ailment affecting the shoulder joint. The clinical efficacy of combined therapy remains uncertain for partial rotator cuff tears. In this study, we integrated extracorporeal shockwave therapy (ESWT) with platelet-rich plasma (PRP) injection, juxtaposed with PRP in isolation. Both cohorts exhibited significant improvements in visual analogue scale (VAS), Constant-Murley score (CMS), degrees of forward flexion, abduction, internal rotation, and external rotation, and the sum of range of motion (SROM) over the six-month assessment period. The application of ESWT in conjunction with PRP exhibited notable additional enhancements in both forward flexion (p = 0.033) and abduction (p = 0.015) after one month. Furthermore, a substantial augmentation in the range of shoulder motion (SROM) (p < 0.001) was observed after six months. We employed isobaric tag for relative and absolute quantitation (iTRAQ) to analyze the differential plasma protein expression in serum samples procured from the two groups after one month. The concentrations of S100A8 (p = 0.042) and S100A9 (p = 0.034), known to modulate local inflammation, were both lower in the ESWT + PRP cohort. These findings not only underscore the advantages of combined therapy but also illuminate the associated molecular changes.