Purpose
The purpose of this study was to compare the outcomes of arthroscopic rotator cuff
repair (ARCR) in patients with preoperative stiffness to those without.
Methods
A total of 135 patients were prospectively evaluated for 2 years after ARCR for small
to medium sized rotator cuff tears at our institution. Patients were divided into
stiff (<100° of passive forward flexion) and non-stiff cohorts. The stiff group underwent
manipulation under anesthesia (MUA) before ARCR was performed. Outcomes were measured
using visual analog scale (VAS), Constant Shoulder Score (CSS), and Oxford Shoulder
Score (OSS) recorded at the preoperative, 6- , 12-, and 24-month time points. The
results of ARCR between the cohorts were then compared.
Results
A total of 123 out of 135 patients (91.1%) completed the follow-up (stiff n = 46,
non-stiff n = 77). There were significant improvements in the mean CSS scores at 6
(mean, 59.87; P < .001) and 12 months (mean, 65.88; P = .021) in the stiff group. There were no significant differences detectable in the
CSS and OSS scores between the stiff and non-stiff groups at 6, 12, and 24 months.
However, the percentage of patients achieving minimal clinically important difference
was significantly higher in the stiff group (97.8%) compared with the non-stiff group
(75.3%; P = .001). The VAS scores, forward flexion, and strength in both groups were found
to be comparable.
Conclusions
The results of our study showed no significant differences in outcomes scores in patients
with stiff shoulders who underwent MUA combined with ARCR compared with patients with
non-stiff shoulders who underwent ARCR alone. Therefore, early surgical repair should
be considered in patients with rotator cuff tears and concomitant shoulder stiffness.
Level of Evidence
Level II, prospective cohort study.
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Article info
Publication history
Published online: July 07, 2020
Accepted:
June 16,
2020
Received:
March 9,
2020
See commentary on page 2962Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2020 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Concomitant Surgical Management for Rotator Cuff Tears With Adhesive Capsulitis is an Effective Treatment for Managing a Vexing ProblemArthroscopyVol. 36Issue 12
- PreviewRotator cuff tears (RCT) with concomitant frozen shoulder is a challenging clinical scenario that I, along with many other shoulder surgeons, commonly encounter. Some controversy exists regarding the optimal treatment. Does one address the shoulder stiffness first and regain range of motion (ROM) via nonoperative or operative means, then treat the rotator cuff tear later, or should it all be done at the same time surgically via a concomitant arthroscopic capsular release with or without manipulation under anesthesia (MUA) followed by a rotator cuff repair (RCR) in the same setting? I believe there is overwhelming evidence in the literature to support the latter.
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