Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Xin , HUANG Fuguo , CHEN Gang , LI Qi , FU Weili ,  LI Jian

Department of Orthopedics, West China Hospital, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LI Jian, Email: hxlijian.china@163.com

Keywords：

Rotator cuff tear; shoulder stiffness; rotator cuff repair; manipulation release; arthroscopy

DOI：

10.7507/1002-1892.201708073

Video：

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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 L₃ 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.

Citation： TANG Xin, HUANG Fuguo, CHEN Gang, LI Qi, FU Weili, LI Jian. Effectiveness of rotator cuff repair with manipulation release and arthroscopic debridement for rotator cuff tear with shoulder stiffness. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 1-6. doi: 10.7507/1002-1892.201708073 Copy

1.	Chuang TY, Ho WP, Chen CH, et al. Arthroscopic treatment of rotator cuff tears with shoulder stiffness: acomparison of functional outcomes with and without capsular release. Am J Sports Med, 2012, 40(9): 2121-2127.
2.	Cho NS, Rhee YG. Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder. Am J Sports Med, 2008, 36(7): 1323-1329.
3.	Oh JH, Kim SH, Lee HK, et al. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy, 2008, 24(9): 983-991.
4.	Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy, 2006, 22(6): 581-586.
5.	Gladstone JN, Bishop JY, Lo IK, et al. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med, 2007, 35(5): 719-728.
6.	Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
7.	Yamaguchi K, Tetro AM, Blam O, et al. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg, 2001, 10(3): 199-203.
8.	Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
9.	Ho WP, Huang CH, Chiu CC, et al. One-stagearthroscopic repair of rotator cuff tears with shoulder stiffness. Arthroscopy, 2013, 29(8): 1283-1291.
10.	Cho CH, Jang HK, Bae KC, et al. Clinical outcomes of rotator cuff repair with arthroscopic capsular release and manipulation for rotator cuff tear with stiffness: a matched-pair comparative study between patients with and without stiffness. Arthroscopy, 2015, 31(3): 482-487.
11.	Park JY, Chung SW, Hassan Z, et al. Effect of capsular release in the treatment of shoulder stiffness concomitant with rotator cuffrepair: diabetes as a predisposing factor associated with treatment outcome. Am J Sports Med, 2014, 42(4): 840-850.
12.	Kim YS, Lee HJ, Park I, et al. Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes. Arthroscopy, 2015, 31(2): 197-204.
13.	Sabzevari S, Kachooei AR, Giugale J, et al. One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review. J Shoulder Elbow Surg, 2017, 26(8): e252-e258.
14.	Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
15.	Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg, 2002, 11(6): 587-594.
16.	Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy, 2006, 22(6): 581-586.
17.	Seo SS, Choi JS, An KC, et al. The factors affecting stiffness occurring with rotator cuff tear. J Shoulder Elbow Surg, 2012, 21(3): 304-309.
18.	Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg, 2005, 14(1): 16-21.
19.	Baums MH, Spahn G, Nozaki M, et al. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports TraumatolArthrosc, 2007, 15(6): 638-644.
20.	Andersen NH, Søjbjerg JO, Johannsen HV, et al. Frozen shoulder: arthroscopy and manipulation under general anesthesia and early passive motion. J Shoulder Elbow Surg, 1998, 7(3): 218-222.

1. Chuang TY, Ho WP, Chen CH, et al. Arthroscopic treatment of rotator cuff tears with shoulder stiffness: acomparison of functional outcomes with and without capsular release. Am J Sports Med, 2012, 40(9): 2121-2127.
2. Cho NS, Rhee YG. Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder. Am J Sports Med, 2008, 36(7): 1323-1329.
3. Oh JH, Kim SH, Lee HK, et al. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy, 2008, 24(9): 983-991.
4. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy, 2006, 22(6): 581-586.
5. Gladstone JN, Bishop JY, Lo IK, et al. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med, 2007, 35(5): 719-728.
6. Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
7. Yamaguchi K, Tetro AM, Blam O, et al. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg, 2001, 10(3): 199-203.
8. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
9. Ho WP, Huang CH, Chiu CC, et al. One-stagearthroscopic repair of rotator cuff tears with shoulder stiffness. Arthroscopy, 2013, 29(8): 1283-1291.
10. Cho CH, Jang HK, Bae KC, et al. Clinical outcomes of rotator cuff repair with arthroscopic capsular release and manipulation for rotator cuff tear with stiffness: a matched-pair comparative study between patients with and without stiffness. Arthroscopy, 2015, 31(3): 482-487.
11. Park JY, Chung SW, Hassan Z, et al. Effect of capsular release in the treatment of shoulder stiffness concomitant with rotator cuffrepair: diabetes as a predisposing factor associated with treatment outcome. Am J Sports Med, 2014, 42(4): 840-850.
12. Kim YS, Lee HJ, Park I, et al. Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes. Arthroscopy, 2015, 31(2): 197-204.
13. Sabzevari S, Kachooei AR, Giugale J, et al. One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review. J Shoulder Elbow Surg, 2017, 26(8): e252-e258.
14. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg (Am), 1986, 68(8): 1136-1144.
15. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg, 2002, 11(6): 587-594.
16. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy, 2006, 22(6): 581-586.
17. Seo SS, Choi JS, An KC, et al. The factors affecting stiffness occurring with rotator cuff tear. J Shoulder Elbow Surg, 2012, 21(3): 304-309.
18. Loew M, Heichel TO, Lehner B. Intraarticular lesions in primary frozen shoulder after manipulation under general anesthesia. J Shoulder Elbow Surg, 2005, 14(1): 16-21.
19. Baums MH, Spahn G, Nozaki M, et al. Functional outcome and general health status in patients after arthroscopic release in adhesive capsulitis. Knee Surg Sports TraumatolArthrosc, 2007, 15(6): 638-644.
20. Andersen NH, Søjbjerg JO, Johannsen HV, et al. Frozen shoulder: arthroscopy and manipulation under general anesthesia and early passive motion. J Shoulder Elbow Surg, 1998, 7(3): 218-222.

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