Arthroscopic Management of Recalcitrant Stiffness Following Rotator Cuff Repair: A Retrospective Analysis
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Rotator Cuff Repair Outcomes
Rotator cuff pathology is the most common cause of shoulder pain in patients over the age of 50 with an incidence of roughly 3.7 per 100 000 and a mean age of 47.5 years in men and 57.2 years in females. Results of both open and arthroscopic rotator cuff repairs are generally good leading to predictable pain relief, increased function, and patient satisfaction. Factors that are commonly associated with a poorer outcome following rotator cuff repair include age, gender, smoking status, and tear size. Additionally, it has been suggested that tendon repair integrity and workman’s compensation status may also affect the surgical outcome.
Arthrofibrosis of the Shoulder Following Rotator Cuff Repair
Post-operative arthrofibrosis of the shoulder is a known complication of both open and arthroscopic surgery and is believed to most commonly result from an intra-articular inflammatory process that leads to thickening and fibrosis of the joint capsule. Risk factors for stiffness following rotator cuff repair (RCR) have been suggested and include diabetes, pre-operative decreased range of motion (ROM), involvement of the subacromial bursa, and arthroscopic findings consistent with adhesive capsulitis. In addition, both technical factors such as inadequate release, over tensioning, and rotator interval closure, as well as an inadequate post-operative protocol have been cited as variables contributing to the development of arthrofibrosis.
Treatment Techniques for Shoulder Shoulder Stiffness After Surgery
The treatment of postoperative arthrofibrosis can be difficult as healing of the rotator cuff requires protected motion and includes both nonoperative and operative modalities. When compared with idiopathic arthrofibrosis, nonoperative treatments such as physical therapy, intra-articular injections, or brisement may not be as successful in treating post-operative stiffness. Surgical treatment in the form of an arthroscopic capsular release in addition to a manipulation under anesthesia has been found to be successful in regaining a functional ROM for multiple etiologies.
It is our belief that manipulation under anesthesia and arthroscopic capsular release followed by an intense therapy protocol is a safe and effective method to treat post-operative stiffness that is refractory to nonoperative measures. Arthroscopic management of shoulder stiffness is preferred because it allows optimal visualization and release of the glenohumeral joint and subacromial space without the added trauma to extra-articular structures, thus allowing immediate full active and passive range of motion (ROM). The purpose of this study is to report our technique and results of patients undergoing arthroscopic capsular release for the treatment of shoulder stiffness following either arthroscopic, mini-open, or open RCR surgery. Our hypothesis is that arthroscopic management of stiffness following RCR would result in significantly improved ROM and improvement in validated outcome measures.
Full Article: Arthroscopic Management of Recalcitrant Stiffness Following Rotator Cuff Repair: A Retrospective Analysis