Paper 165: Arthroscopic Management of Stiffness Following Rotator Cuff Repair: Techniques and Results

Abstract

Stiffness is the most common complication following rotator cuff repair independent of repair technique. The purpose of this study is to identify a cohort of patients who developed stiffness following rotator cuff repair and to report the results following arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy. Operative logs of the four senior surgeons were reviewed and thirty-one patients who underwent an arthroscopic lysis of adhesions between July 2004 and April 2007 for the treatment of arthrofibrosis following either an arthroscopic (56%), open (28%), or mini-open (16%) rotator cuff repair were identified. Data was obtained retrospectively from chart reviews and each patient was re-evaluated for purposes of this study by a single examiner. The average follow-up was 24.0 months (range, 12 to 41 months, sd 10) at which time range of motion (ROM), outcome scores (American Shoulder and Elbow Surgeons Score, Constant-Murley, Visual Analog Score, and Simple Shoulder Test), and dynamometer strength testing was recorded. Prior to arthroscopic lysis of adhesions, shoulder ROM averaged: 104.5 degrees of forward elevation (FE) and 27.2 degrees of external rotation at the side (ERS). At most recent follow-up, a significant increase in ROM was noted with FE of 150.2 degrees (p<0.001) and ERS of 56.2 degrees (p<0.001). Subjective outcome scores and strength were also improved. There were 3 (10%) failures requiring a repeat operative procedure for recurrent stiffness. There was no difference in outcomes with regard to index surgery repair technique (arthroscopic, open or mini-open repair). There were no complications such as dislocation, infection, or nerve injury. Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Furthermore, significant improvement in shoulder ROM, strength, subjective outcome scores, and patient satisfaction can be expected with an arthroscopic technique and aggressive rehabilitation treatment protocol.