Regarding “Delaying Surgery for Rotator Cuff Tears With Concomitant Stiffness”

Abstract

I wish to thank Kim et al. for their article titled “Are Delayed Operations Effective for Patients with Rotator Cuff Tears and Concomitant Stiffness? An Analysis of Immediate Versus Delayed Surgery on Outcomes.”1Kim Y.-S. Lee H.-J. Park I. Im J.-H. Park K.-S. Lee S.-B. Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes.Arthroscopy. 2015; 31: 197-204Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar The authors compared outcome after concomitant rotator cuff repair and capsular release with that of 6 months of “preoperative rehabilitation” followed by rotator cuff repair. They recommended that because a delayed rotator cuff repair after improving ROM offered no clear advantage over an immediate operation, patients with stiffness and rotator cuff tears should be treated with early concomitant rotator cuff repair and capsular release. This may be so, but the authors were using 2 different treatments for management of the stiffness, so they were not really comparing like with like. In group 1, the stiffness was treated with early capsular release in all patients, whereas in group 2, in the vast majority of the patients the stiffness was treated with 6 months of preoperative rehabilitation. Had they compared outcome of early capsular release followed by delayed repair with that of concomitant rotator cuff repair and capsular release, the result may have been different, and the former group might have shown a better outcome. In fact, they do mention that 6 patients in group 2 had capsular release after 6 months of rehabilitation, but it is not clear at what stage after release they underwent rotator cuff repair. I wish to thank Kim et al. for their article titled “Are Delayed Operations Effective for Patients with Rotator Cuff Tears and Concomitant Stiffness? An Analysis of Immediate Versus Delayed Surgery on Outcomes.”1Kim Y.-S. Lee H.-J. Park I. Im J.-H. Park K.-S. Lee S.-B. Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes.Arthroscopy. 2015; 31: 197-204Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar The authors compared outcome after concomitant rotator cuff repair and capsular release with that of 6 months of “preoperative rehabilitation” followed by rotator cuff repair. They recommended that because a delayed rotator cuff repair after improving ROM offered no clear advantage over an immediate operation, patients with stiffness and rotator cuff tears should be treated with early concomitant rotator cuff repair and capsular release. This may be so, but the authors were using 2 different treatments for management of the stiffness, so they were not really comparing like with like. In group 1, the stiffness was treated with early capsular release in all patients, whereas in group 2, in the vast majority of the patients the stiffness was treated with 6 months of preoperative rehabilitation. Had they compared outcome of early capsular release followed by delayed repair with that of concomitant rotator cuff repair and capsular release, the result may have been different, and the former group might have shown a better outcome. In fact, they do mention that 6 patients in group 2 had capsular release after 6 months of rehabilitation, but it is not clear at what stage after release they underwent rotator cuff repair. Are Delayed Operations Effective for Patients With Rotator Cuff Tears and Concomitant Stiffness? An Analysis of Immediate Versus Delayed Surgery on OutcomesArthroscopyVol. 31Issue 2PreviewThe purpose of this study was to compare the clinical outcomes of immediate rotator cuff repair with capsular release and those of rotator cuff repair after the stiffness was treated with rehabilitative therapy. Full-Text PDF Authors' ReplyArthroscopyVol. 31Issue 9PreviewWe thank Dr. Narvani for his great interest in our study. Regarding his opinion on our article, there are a few important issues about which we should be clear. Like he said, the result would have been different if group 2 had early surgical capsular release and delayed rotator cuff repair. However, the focus of this study was on the treatment of shoulder stiffness with rotator cuff tears, not stiffness only. In other words, all the enrolled patients will eventually undergo surgical procedures for the repair of rotator cuff tears. Full-Text PDF