Huberty David P, Schoolfield John D, Brady Paul C, Vadala Antonio P, Arrigoni Paolo, Burkhart Stephen S
Oregon Orthopedics and Sports Medicine Clinic, LLP, Oregon City, Oregon, USA.
Arthroscopy. 2009 Aug;25(8):880-90. doi: 10.1016/j.arthro.2009.01.018.
The purpose of this study was to determine the incidence of clinically significant postoperative stiffness following arthroscopic rotator cuff repair. This study also sought to determine the clinical and surgical factors that were associated with higher rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic lysis of adhesions and capsular release for treatment of patients who developed refractory postoperative stiffness 4 to 19 months (median, 8 months) following arthroscopic rotator cuff repair.
A retrospective review of a consecutive series of arthroscopic rotator cuff repairs was conducted. During a 3-year time period, the senior author (S.S.B.) performed 489 arthroscopic rotator cuff repairs. The operative indications, technique of the rotator cuff repair, and the rehabilitation protocol were essentially unchanged during this time period. Demographic data, comorbid medical conditions, rotator cuff tear description, technique of repair, and concomitant surgical procedures were evaluated for their effect on stiffness. All office evaluations were reviewed to determine the pre- and postoperative motion, pain scores, functional strength, and patient satisfaction. Patients who were dissatisfied because of the development of postoperative stiffness underwent secondary arthroscopic lysis of adhesions. The final result of the secondary lysis of adhesions and capsular release were analyzed.
In total, 24 patients (4.9%) were dissatisfied with the result of their procedure because of the development of postoperative stiffness, which was more likely (P < .05) to develop in patients with Workers' Compensation insurance (8.6%), patients younger than 50 years of age (8.6%), those with a coexisting diagnosis of calcific tendonitis (16.7%) or adhesive capsulitis (15.0%) requiring additional postoperative therapy, partial articular-sided tendon avulsion (PASTA) type rotator cuff tear (13.5%), or concomitant labral repair (11.0%). Patients with concomitant coracoplasty (2.3%) or tears larger in size and/or involving more tendons were less likely (P < .05) to develop postoperative stiffness. Among 90 patients positive for selected risk factors (adhesive capsulitis, excision of calcific deposits, single-tendon repair, PASTA repair, or any labral repair without a concomitant coracoplasty), 12 (13.3%) developed postoperative stiffness (P < .001). This overall clinical risk factor combined with Workers' Compensation insurance identified 16 of the 24 cases resulting in a sensitivity of 66.7% and a specificity of 64.5%. All 24 patients who experienced postoperative stiffness elected to undergo arthroscopic lysis of adhesions and capsular release, which was performed from 4 to 19 months (median, 8 months) after the rotator cuff repair. During second-look arthroscopy, 23 patients (95.8%) were noted to have complete healing of the original pathology. Following capsular release, all 24 patients were satisfied with the overall result of their treatment.
In a series of 489 consecutive arthroscopic rotator cuff repairs, we found that 24 patients (4.9%) developed postoperative stiffness. Risk factors for postoperative stiffness were calcific tendinitis, adhesive capsulitis, single-tendon cuff repair, PASTA repair, being under 50 years of age, and having Workers' Compensation insurance. Twenty-three of 24 patients (95.8%) showed complete healing of the rotator cuff. Arthroscopic release resulted in normal motion in all cases.
Level IV, therapeutic case series.
本研究旨在确定关节镜下肩袖修补术后具有临床意义的关节僵硬的发生率。本研究还试图确定与术后关节僵硬发生率较高相关的临床和手术因素。最后，我们分析了关节镜下粘连松解和关节囊松解术治疗关节镜下肩袖修补术后4至19个月（中位数为8个月）出现难治性术后关节僵硬患者的结果。
对一系列连续的关节镜下肩袖修补病例进行回顾性研究。在3年的时间里，资深作者（S.S.B.）进行了489例关节镜下肩袖修补术。在此期间，手术指征、肩袖修补技术和康复方案基本保持不变。评估人口统计学数据、合并的内科疾病、肩袖撕裂的描述、修补技术和同期手术对关节僵硬的影响。回顾所有门诊评估结果，以确定术前和术后的活动度、疼痛评分、功能强度和患者满意度。因术后关节僵硬而不满意的患者接受了二次关节镜下粘连松解术。分析二次粘连松解和关节囊松解术的最终结果。
共有24例患者（4.9%）因术后关节僵硬对手术结果不满意，这些患者更有可能（P < 0.05）出现在有工伤赔偿保险的患者中（8.6%）、年龄小于50岁的患者中（8.6%）、同时诊断为钙化性肌腱炎（16.7%）或粘连性关节囊炎（15.0%）需要额外术后治疗的患者中、部分关节侧肌腱撕脱（PASTA）型肩袖撕裂（13.5%）或同期进行盂唇修补的患者中（11.0%）。同期进行喙突成形术的患者（2.3%）或撕裂尺寸更大和/或涉及更多肌腱的患者发生术后关节僵硬的可能性较小（P < 0.05）。在90例具有选定危险因素（粘连性关节囊炎、钙化沉积物切除、单肌腱修补、PASTA修补或任何未同期进行喙突成形术的盂唇修补）阳性的患者中，12例（13.3%）发生了术后关节僵硬（P < 0.001）。这种总体临床危险因素与工伤赔偿保险相结合，在24例病例中识别出16例，敏感性为66.7%，特异性为64.5%。所有24例经历术后关节僵硬的患者均选择接受关节镜下粘连松解和关节囊松解术，该手术在肩袖修补术后4至19个月（中位数为8个月）进行。在二次关节镜检查时，23例患者（95.8%）原发病理完全愈合。关节囊松解术后，所有24例患者对治疗的总体结果均满意。
在连续489例关节镜下肩袖修补病例中，我们发现24例患者（4.9%）出现了术后关节僵硬。术后关节僵硬的危险因素包括钙化性肌腱炎、粘连性关节囊炎、单肌腱袖带修补、PASTA修补、年龄小于50岁和有工伤赔偿保险。24例患者中有23例（95.8%）肩袖完全愈合。关节镜下松解术在所有病例中均使活动度恢复正常。
IV级，治疗性病例系列。
