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

Abstract

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.

MicroRNA-29a Mitigates Subacromial Bursa Fibrosis in Rotator Cuff Lesion with Shoulder Stiffness

“…Patients with rotator cuff tears with shoulder stiffness had limited motion of shoulder joints, like significant reductions in functional score of Constant and Murley together with SROM. Our analysis was in agreement with other groups’ investigations showing that patients inflicted with this disorder, independent of the gender, BMI, and involved side, underperformed in shoulder function [35,36,37]. While the cause of shoulder stiffness remains unclear, increasing evidence reveals that defective subacromial bursa integrity is associated with the shoulder disorder.…”

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

“…Arthroscopic rotator cuff repair (ARCR) can lead to satisfactory functional outcomes in 80% of cases and is recommended as an optimal treatment for symptomatic RCTs [ 5 , 6 ]. However, shoulder stiffness with concomitant RCTs remains a difficult problem for surgeons, and the optimal treatment remains controversial [ 7 – 10 ].…”

“…Thus, some surgeons prefer to delay the operation until the recovery of ROM and relief of symptoms [ 2 ]. However, two-stage treatment involving conservative treatment prior to ARCR did not achieve more desirable outcomes than one-stage treatment [ 9 , 10 ]. This strategy may aggravate RCTs due to a prolonged treatment period, reduce patient satisfaction and create an additional financial burden; furthermore, not all patients can tolerate pain during the rehabilitation process [ 9 , 10 ].…”

“…However, two-stage treatment involving conservative treatment prior to ARCR did not achieve more desirable outcomes than one-stage treatment [ 9 , 10 ]. This strategy may aggravate RCTs due to a prolonged treatment period, reduce patient satisfaction and create an additional financial burden; furthermore, not all patients can tolerate pain during the rehabilitation process [ 9 , 10 ]. Meanwhile, some surgeons believe that RCTs result in persistent pain and capsular contracture, which may exacerbate the stiffness of the shoulder [ 11 – 13 ].…”

Functional outcome of single stage capsular release and rotator cuff repair for cuff tear in periarthritic shoulder

“…But this leads to prolonged recovery time and patient dissatisfaction. 8 Simultaneous management of both conditions allows for early rehabilitation, good pain relief, reduced recovery time. 9,10 So here in this study we had attempted combined management of periarthritic shoulder and rotator cuff injury with capsular release and rotator cuff repair and its functional outcome had been evaluated.…”