Summary

Surgeons can treat many stiff shoulders associated with rotator cuff tear with ARCR combined with MUA alone, and arthroscopic capsular release is not always necessary.

Abstract

Background

Only a few studies have reported the clinical outcomes and rotator cuff integrity of arthroscopic rotator cuff repair (ARCR) with manipulation under anesthesia (MUA) alone in patients with preoperative stiffness. This study aimed to compare the clinical outcomes and retear rates of ARCR between patients with preoperative shoulder stiffness who underwent MUA alone and patients without shoulder stiffness.

Methods

This retrospective study involved 361 patients who underwent ARCR from January 2012 to August 2019. Inclusion criteria were full-thickness tears with a minimum of a 2-year follow-up. The stiff group included the patients who underwent MUA without arthroscopic capsular release before ARCR. Clinical outcome measures had a passive range of motion (ROM), Japanese Orthopedic Association (JOA), and University of California, Los Angeles (UCLA) scores at pre-surgery, 3,6,12, and 24 months post-surgery. Rotator cuff retear was evaluated with magnetic resonance imaging (MRI) within six months after surgery.

Results

Sixty-nine patients with stiffness and 151 patients without stiffness met the inclusion criteria. Preoperative ROM, JOA, and UCLA scores were significantly lower in the stiffness group. Both groups showed significant improvement in ROM except ER in the non-stiff group, JOA, and UCLA scores at the final follow-up. There was no significant difference in ROM except in external rotation (ER) and clinical scores at the final follow-up, . Retear rate of the stiffness group (10.9%) was not significantly different from that of the non-stiffness group (14.0%).

Conclusions

The study showed comparable clinical outcomes and rotator cuff integrity of ARCR between patients with preoperative shoulder stiffness who underwent MUA alone and patients without shoulder stiffness. The results suggested that surgeons can treat many stiff shoulders associated with rotator cuff tear with ARCR combined with MUA alone, and arthroscopic capsular release is not always necessary.