Are Delayed Operations Effective for Patients With Rotator Cuff Tears and Concomitant Stiffness? An Analysis of Immediate Versus Delayed Surgery on Outcomes

Kim, Yang-Soo; Park, In; Im, Jin-Hyung; Park, Kwang-Sun; Lee, Seung-Bin

doi:10.1016/j.arthro.2014.08.014

Cited by 40 publications

(59 citation statements)

References 33 publications

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“…Chuang et al [3] reported on a cohort of 72 patients who underwent rotator cuff repair and found that 40% of the patients exhibited concomitant shoulder stiffness. According to the published literature [3–5, 11, 18], factors leading to shoulder stiffness in patients with rotator cuff tear include the following: (1) the pain from rotator cuff tears results in joint disuse, contracture of the joint capsule, and secondary muscular weakness, which would ultimately facilitate joint stiffness; (2) secondary adhesive capsulitis, which is precipitated by inflammation from the rotator cuff tear, could also contribute to joint stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, six patients refused to tolerate the remaining rehabilitation period due to severe pain during stretching exercises. In another study by Huberty et al [11], the author also reported on a series of 33 patients who underwent conservative treatment before rotator cuff repair, and six patients (18.2%) withdrew due to severe pain during rehabilitation; (2) nonsurgical treatment for shoulder stiffness may be insufficient, especially in the presence of rotator cuff lesions [23–25]; (3) in addition, inappropriate exercise could lead to fatigue accumulation in the damaged tendon, which could potentially exacerbate the rotator cuff injury [11].…”

Section: Discussionmentioning

confidence: 99%

“…Traditionally, when a patient experiences a rotator cuff tear with concomitant shoulder stiffness, the stiffness should be addressed initially through conservative treatment prior to rotator cuff repair because the repair is a “shoulder-tightening” procedure and might increase the rate of postoperative shoulder stiffness [8–10]. However, this two-stage procedure would prolong patient’s suffering given the delay in surgery, and the rotator cuff tear might extend during the treatment for stiffness [5–7, 11–13]. A one-stage procedure was recently proposed for the management of patients with rotator cuff tears and concomitant stiffness [6, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…However, this two-stage procedure would prolong patient’s suffering given the delay in surgery, and the rotator cuff tear might extend during the treatment for stiffness [5–7, 11–13]. A one-stage procedure was recently proposed for the management of patients with rotator cuff tears and concomitant stiffness [6, 11, 12]. However, to our knowledge, there are limited data comparing the clinical outcomes of one-stage and two-stage procedures for treatment of patients with rotator cuff tear and concomitant stiffness.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of one-stage versus two-stage procedure for the management of patients with rotator cuff tear and concomitant shoulder stiffness

Zhuo

2019

J Orthop Surg Res

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BackgroundTo compare the clinical outcomes of one-stage and two-stage procedures for the management of patients with rotator cuff tear and concomitant shoulder stiffness.MethodsFrom December 2013 to June 2016, we recruited 42 consecutive patients with rotator cuff tear and concomitant shoulder stiffness. Twenty-two patients underwent a one-stage procedure, including arthroscopic capsule release and concomitant rotator cuff repair, within 2 weeks of the diagnosis. For the remaining twenty patients, conservative treatment for the recovery of range of motion (ROM) was initially performed before arthroscopic rotator cuff repair. The ROM, visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, and satisfaction rate were assessed preoperatively; 3, 6, 12, and 24 months after surgery; and at final follow-up.ResultsThe mean follow-up period was 26.3 months (range, 24–33 months). No significant difference was noted in preoperative demographic data (age, sex, dominant/non-dominant, diabetes mellitus, thyroid disease, and duration of symptoms) between the two groups (P = 0.165, P = 0.580, P = 0.662, P = 0.716, P = 0.231, and P = 0.152, respectively). After treatment, all patients exhibited significant improvement in ROM and functional scores (P = 0.001 and P = 0.001, respectively). At 3 months postoperatively, the two-stage group exhibited significantly improved forward flexion and internal rotation compared with the one-stage group (P = 0.001 and P = 0.038, respectively). No significant difference in ROM was noted between the two groups at 6, 12, 24 months postoperatively and the final follow-up. In addition, no significant differences in VAS, ASES, Constant-Murley score and satisfaction rate were noted between the two groups at final follow-up (P = 0.319, P = 0.529, P = 0.711, and P = 0.085, respectively).ConclusionIn the treatment of rotator cuff tear with concomitant stiffness, although the recovery of ROM took longer in patients who underwent the one-stage procedure, satisfactory results at final follow-up can be achieved using either the one-stage procedure or two-stage procedure.Study designCase-control study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of one-stage versus two-stage procedure for the management of patients with rotator cuff tear and concomitant shoulder stiffness

Zhuo

2019

J Orthop Surg Res

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“…There are no universally accepted criteria for the diagnosis of stiffness, but we determined stiffness by passive range of shoulder motion to be forward flexion of less than 100° (maximal 150°; forward flexion is glenohumeral motion without scapulohumeral rhythm), ER of less than 45°, or IR of the back at a level lower than the first lumbar spine junction. 17,19) Plain radiographs of the shoulder (true anteroposterior, supraspinatus outlet, and axial view) and shoulder magnetic resonance imaging were checked in all patients.…”

Section: Methodsmentioning

confidence: 99%

A Randomized Comparative Study of a Standard Anterior Capsular Release versus Inferior Extended Release for the Treatment of Shoulder Stiffness

Alzeyadi¹,

Kim

Park³

et al. 2017

Clinics in Shoulder and Elbow

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Background: To compare the clinical outcomes of arthroscopic capsular release in patients with and without inferior capsular release for shoulder stiffness. Methods: Between January 2010 and December 2015, 39 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into two groups. In group I, 19 patients underwent arthroscopic capsular release of the rotator interval and anterior capsule. In group II, 20 patients underwent arthroscopic capsular release of the anterior to inferior capsule, including the rotator interval. The American Shoulder and Elbow Surgeons score, Constant scoring system, Simple Shoulder Test, visual analogue scale for pain, and range of motion (ROM) were used for evaluation before surgery, at 3, 6, and 12 months after surgery and on the last follow-up. Results: Preoperative demographic data revealed no significant differences (p>0.05). The average follow-up was 16.07 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative (p<0.05). At the last follow-up, no statistical differences were found (p>0.05) between groups I and II in functional scores and ROM (forward flexion, p=0.91; side external rotation, p=0.17; abduction external rotation, p=0.72; internal rotation, p=0.61). But we found that group II gained more flexion compared to group I at 3 months and 6 months (p<0.05) after the surgery. Conclusions: Both techniques of capsular release are effective for stiffness shoulder. However, the extended inferior capsular release shows superiority in forward flexion over anterior capsular release alone during 6 months of follows-up (level of evidence: Level I, therapeutic randomized controlled trial). (Clin Shoulder Elbow 2017;20(3):117-125)

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Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair

Yoo,

Kang,

Kim

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aimed to compare the 5‐year clinical and functional outcomes, including repaired tendon healing status, between early and delayed rehabilitation after arthroscopic rotator cuff repairMethodsA total of 75 patients with rotator cuff tears (less than 5 cm) underwent arthroscopic repairs over a 60‐month period. Participants were randomly assigned to early and delayed postoperative rehabilitation groups with distinct protocols. Clinical and functional outcome measures included Constant score, University of California at Los Angeles (UCLA) score, visual analogue scale for pain and isokinetic dynamometer test for muscle strength recovery. Clinical and functional scores were compared between baseline and 5 years postoperatively. Radiologic assessment via magnetic resonance imaging was performed at a minimum of 12 months postoperatively for evaluations of tendon integrity and recurrent tears.ResultsBaseline characteristics showed no statistically significant differences between groups. Both groups demonstrated equivalent improvement in range of motion and pain scores with no statistical differences. Clinical scores improved significantly in both groups by postoperative 12 months and plateaued. At the postoperative 5‐year mark, the early group showed better improvement in the visual analogue scale and UCLA score, while the delayed group had superior Constant scores. Postoperative magnetic resonance imaging revealed six recurrent tears, two in the early group and four in the delayed group, with no statistical differences. Muscle strength recovery showed no differences between the two groups.ConclusionBoth the early and the delayed rehabilitation groups showed similar outcomes in postoperative range of motion, functional scores, muscle strength recovery and tendon healing in the short‐ and mid‐term follow‐ups.Level of EvidenceLevel III.

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Are Delayed Operations Effective for Patients With Rotator Cuff Tears and Concomitant Stiffness? An Analysis of Immediate Versus Delayed Surgery on Outcomes

Cited by 40 publications

References 33 publications

Comparison of one-stage versus two-stage procedure for the management of patients with rotator cuff tear and concomitant shoulder stiffness

Comparison of one-stage versus two-stage procedure for the management of patients with rotator cuff tear and concomitant shoulder stiffness

A Randomized Comparative Study of a Standard Anterior Capsular Release versus Inferior Extended Release for the Treatment of Shoulder Stiffness

Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair

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