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.
Highlights
Rotator cuff tear is a common condition that causes shoulder pain and dysfunction in daily life [1, 2]
The inclusion criteria were as follows: (1) patients with a small-sized or mediumsized full-thickness rotator cuff tear; (2) patients with a concomitant limited passive range of motion (ROM): forward flexion was less than 100° passively, external rotation with the arm at the side was less than 30° passively, and internal rotation of a vertebral level where the thumb reached was lower than the first lumbar spine junction passively; (3) patients with a minimum follow-up period of 2 years
Range of motion Before treatment, no significant difference in ROM was observed between the two groups (P > 0.05, Figs. 4, 5, and 6)
Summary
Rotator cuff tear is a common condition that causes shoulder pain and dysfunction in daily life [1, 2]. 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 [8,9,10]. 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. To compare the clinical outcomes of one-stage and two-stage procedures for the management of patients with rotator cuff tear and concomitant shoulder stiffness
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