Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair

Jeung Yeol Jeong; Seung Bo Shim; Jin Ho Hong; Wooyoung Im; Sang Min Lee; Jae Chul Yoo

doi:10.1177/2325967120934449

Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair

Orthop J Sports Med. 2020 Jul 24;8(7):2325967120934449. doi: 10.1177/2325967120934449. eCollection 2020 Jul.

Authors

Jeung Yeol Jeong¹, Seung Bo Shim², Jin Ho Hong³, Wooyoung Im¹, Sang Min Lee⁴, Jae Chul Yoo³

Affiliations

¹ Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea.
² Department of Orthopedic Surgery, Seoul Barun Hospital, Seoul, Republic of Korea.
³ Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
⁴ Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Abstract

Background: A concomitant rotator cuff tear (RCT) with frozen shoulder is a common but challenging clinical scenario. The effect of frozen shoulder on clinical outcomes is open to discussion.

Purpose/hypothesis: This study aimed to evaluate the effect of preoperative frozen shoulder on postoperative clinical outcomes of an RCT. We hypothesized that the treatment results of an RCT concomitant with preoperative frozen shoulder would be comparable with those of an isolated RCT.

Study design: Cohort study; Level of evidence, 3.

Methods: A total of 212 patients were divided into 2 groups: 154 in the non-frozen shoulder (NFS) group and 58 in the preoperative frozen shoulder (FS) group. All patients underwent a thorough preoperative evaluation that included range of motion (ROM) and the pain visual analog scale, functional visual analog scale, Constant score, and American Shoulder and Elbow Surgeons (ASES) score. The same evaluation was performed at 6 months and 1 and 2 years postoperatively. The healing status of the repaired RCT of all patients was evaluated by postoperative magnetic resonance imaging.

Results: The FS group showed statistically significantly worse functional outcomes than the NFS group at 6 months and 1 year postoperatively (P < .05). At 2 years postoperatively, active assisted ROM was equivalent between the groups, although the ASES and Constant scores were significantly lower for the FS group (P < .033 and P < .001, respectively). The retear rates were 5.3% and 12.3% for the FS and NFS groups, respectively (P = .013).

Conclusion: Preoperative frozen shoulder positively affected rotator cuff healing but negatively affected most functional outcomes, including ROM, at 6 months and 1 year postoperatively. At 2 years after surgery, there was no significant difference in active motion, but outcome scores remained lower in the FS group. For patients with preoperative frozen shoulder, a delay in surgery for additional physical therapy might not be necessary. The retear rate for the NFS group was more than double that for the FS group in the current study, which indicates that surgery for an RCT combined with frozen shoulder might provide better results in the long term because of an intact, healed rotator cuff.

Keywords: capsular release; frozen shoulder; retear; stiffness; tear size.