Arthroscopic Rotator Cuff Repair in Patients with Concomitant Moderate to Severe Stiffness (SS-14)

Abstract

Introduction The results of arthroscopic rotator cuff repair have been excellent and reproducible in several studies. Some patients with full thickness rotator cuff tears also present with, or subsequently develop significant shoulder stiffness preoperatively. While resolution of shoulder stiffness prior to rotator cuff repair would seem a desirable goal, some patients remain very stiff despite extensive nonoperative intervention. The treatment of rotator cuff tears in the face of persistent moderate to severe stiffness is controversial. Few articles have evaluated the outcomes of rotator cuff repair in patients with concomitant stiffness. Some authors have even recommended staged surgical procedures, first addressing the stiffness and then subsequently reoperating and repairing the rotator cuff tear. The purpose of this study is to evaluate the results of a consecutive group of patients who underwent both arthroscopic rotator cuff repair and arthroscopic capsular release due to persistent shoulder stiffness. Methods A prospective case series was conducted of patients who underwent both arthroscopic capsular release and arthroscopic rotator cuff repair in the same setting between January 1, 2004, and December 31, 2008. Forty-one patients were identified and a retrospective review of these medical records was performed. Data was collected including pre- and postoperative range of motion, strength, size of cuff tear, and pre- and post operative UCLA shoulder scores. Inclusion criterion included passive forward flexion Results Forty-one patients underwent both arthroscopic capsular release and arthroscopic rotator cuff repair in the same setting. 5 of these patients were excluded due to lack of follow up. Of the 36 patients, 23 were female and 13 were male. The average age was 59.5 (37-81). The mean duration of non-operative treatment prior to surgical intervention was 5.5 months (2-24 months). Average forward flexion improved from 106 degrees (10-120°) to 159 degrees (110-180°). Average external rotation improved from 4.34 degrees (−10-10°) to 65° (45-90°). The mean preoperative UCLA Score was 14.8 (6-21). These improved postoperatively to a mean of 32.2 (20-35) (p Conclusion Patients in this study who have combined moderate to severe shoulder stiffness and a documented rotator cuff tear demonstrated an improvement in range of motion comparable to other published results for isolated capsular release. Additionally, the improvement in UCLA scores mirrors other authors' results for the treatment of isolated rotator cuff tear without concurrent stiffness. Therefore, the authors feel that this combined approach can be used to effectively treat patients with resistant moderate to severe stiffness and concomitant rotator cuff tears.