Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair

Parker L Brush; Adrian Santana; Ruchir Nanavati; Gregory R Toci; Tariq Z Issa; Daniel J Fletcher; Joshua Hornstein

doi:10.1016/j.asmr.2023.05.008

Arthroscopic Treatment of Shoulder Stiffness With Rotator Cuff Repair Yields Similar Outcomes to Isolated Rotator Cuff Repair

Arthrosc Sports Med Rehabil. 2023 Jul 25;5(4):100751. doi: 10.1016/j.asmr.2023.05.008. eCollection 2023 Aug.

Authors

Parker L Brush¹, Adrian Santana², Ruchir Nanavati³, Gregory R Toci¹, Tariq Z Issa¹, Daniel J Fletcher¹, Joshua Hornstein¹

Affiliations

¹ Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
² Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A.
³ Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.

Abstract

Purpose: To compare patient-reported and surgical outcome measures in patients with and without secondary shoulder stiffness (SSS) undergoing rotator cuff repair (RCR).

Methods: Patients undergoing rotator cuff repair from 2014 to 2020 with complete patient-reported outcome measures (PROMs) by the short-form 12 survey (SF-12) were retrospectively reviewed to identify if operative intervention for SSS was performed alongside the RCR. Those patients with operative intervention for SSS were propensity matched to a group without prior intervention for stiffness by age, sex, laterality, body mass index, diabetes mellitus status, and the presence of a thyroid disorder. The groups were compared by rotator cuff tear (RCT) size, surgical outcomes, further surgical intervention, rotator cuff retear rate, postoperative range of motion (ROM), and SF-12 results at 1 year after surgery. Delta values were calculated for component scores of the SF-12 and ROM values by subtracting the preoperative result from the postoperative result.

Results: A total of 89 patients with SSS were compared to 156 patients in the control group at final analysis. The patients in the SSS group experienced a significant improvement in the delta mental health component score (MCS-12) of the SF-12 survey that was not seen in the control group (P = .005 to P = .539). Both groups experienced significant improvement by the delta physical health component score (PCS-12) of the SF-12 survey (SSS: 7.68; P < .001; control: 6.95; P < .001). The SSS group also experienced greater improvement of their forward flexion (25.8° vs 12.9°; P = .005) and external rotation (7.13° vs 1.65°; P = .031) ROM than the control group.

Conclusions: Operative intervention of SSS at the time of RCR has equivalent postoperative SF-12 survey outcome scores when compared to patients undergoing RCR without preoperative stiffness despite those patients having lower preoperative scores.

Level of evidence: Level III retrospective comparative study.