Clinical and structural outcome of intra-articular steroid injection for early stiffness after arthroscopic rotator cuff repair

Abstract

Purpose: Direct comparative results of patients with early stiffness after arthroscopic rotator cuff repair (ARCR) with and without steroid injection are still unclear. This study aimed to evaluate the clinical and structural effect of intra-articular steroid injection for early stiffness after ARCR.

Methods: From 2011 and 2016, a total of 417 patients who underwent ARCR for less than medium-sized tears with 35.8 ± 22.6 months follow-up were retrospectively analyzed. Patients with shoulder stiffness [forward flexion (FF) < 120˚] or pain at 2 months after ARCR were performed intra-articular steroid injection, and four groups were established [+ stiffness/ + injection (SI, 158 patients), + stiffness/-injection (SNI, 92 patients), -stiffness/ + injection (NSI, 33 patients), and -stiffness/-injection (NSNI, 134 patients)]. Shoulder range-of-motion (ROM) and functional score changes for over two years were analyzed, and six month tendon integrity were evaluated using magnetic resonance imaging.

Results: Comparing SI and SNI group, ROM (except internal rotation) and functional score changes did not differ during the early period (2-6 and 2-12 months). However, comparing whether steroid injected (SI/NSI) or not (SNI/NSNI), the formers showed significantly higher improvement of both ROM and functional scores during the early and late period (2-24 months). A six month tendon integrity was not different across four groups and whether steroid injected or not.

Conclusions: Intra-articular steroid injections do not appear to have a short-term clinical improving effect by comparing patients with stiff shoulders after ARCR with and without steroid injections. However, intra-articular steroid injection at two months after ARCR did not affect the tendon integrity at post-operative six months.

Keywords: Retear; Rotator cuff repair; Shoulder stiffness; Steroid.