The San Antonio Orthopaedic Group, San Antonio, Texas, USA.
Arthroscopy. 2011 Jun;27(6):842-8. doi: 10.1016/j.arthro.2011.01.013.
To define the incidence of stiffness after arthroscopic rotator cuff repair (ARCR) and address the prevention and management of postoperative stiffness.
A PubMed search was performed using the combined terms "rotator cuff and stiffness," "shoulder and capsular release," and "capsular release and stiffness." Inclusion criteria were (1) primary outcome of postoperative shoulder stiffness, (2) Levels I to IV evidence, and (3) entirely arthroscopic technique for rotator cuff repair.
Seven articles met our inclusion criteria. Two articles discussed the management of preoperative stiffness and ARCR. These articles managed preoperative stiffness differently, preventing an adequate comparison to provide recommendations. Three articles described both the incidence of and risk factors for postoperative stiffness after ARCR. The incidence of transient stiffness responsive to nonoperative management was 10%. The incidence of resistant stiffness that was permanent or required capsular release was 3.3%. Several risk factors for stiffness were identified in this review. Two articles focused on postoperative rehabilitation protocols and stiffness after ARCR. Overall, resistant postoperative stiffness was reported in 1.5% of patients with an immediate passive range-of-motion protocol, 4.5% of patients in a 6-week sling-immobilization protocol, and 0% of patients with a modified protocol. Three articles, all among the above mentioned articles, reported that arthroscopic capsular release for stiffness after ARCR improved motion to a level comparable to that in patients who did not require reoperation.
The studies in this systematic review indicate that with ARCR, postoperative stiffness resistant to nonoperative management is uncommon despite an initial immobilization period. In the setting of resistant postoperative stiffness, arthroscopic capsular release can successfully restore range of motion. ARCR allows a delayed mobilization protocol that may be important in achieving rotator cuff healing. The optimal management of preoperative stiffness in patients undergoing ARCR is inconclusive based on this review.
Level IV, systematic review of Level III and IV studies.
定义关节镜肩袖修复（ARCR）后僵硬的发生率，并探讨术后僵硬的预防和处理。
使用“肩袖和僵硬”、“肩部和囊松解”以及“囊松解和僵硬”的组合术语对 PubMed 进行检索。纳入标准为：（1）术后肩部僵硬的主要结果，（2）I 级至 IV 级证据，以及（3）完全采用关节镜技术进行肩袖修复。
符合纳入标准的文章有 7 篇。其中 2 篇文章讨论了术前僵硬和 ARCR 的处理。这些文章对术前僵硬的处理方式不同，无法进行充分比较以提供建议。另外 3 篇文章描述了 ARCR 后术后僵硬的发生率和危险因素。对非手术治疗有反应的一过性僵硬的发生率为 10%。需要进行囊松解的持续性僵硬或永久性僵硬的发生率为 3.3%。该综述确定了几个僵硬的危险因素。有 2 篇文章重点介绍了 ARCR 后的术后康复方案和僵硬情况。总体而言，立即开始被动活动范围方案的患者中，有 1.5%报告出现僵硬，6 周吊带固定方案的患者中，有 4.5%报告出现僵硬，而采用改良方案的患者中，没有出现僵硬。上述文章中的 3 篇文章均报告称，对于 ARCR 后因僵硬而进行的关节镜下囊松解可以改善运动范围，使其与无需再次手术的患者相当。
本系统评价中的研究表明，尽管有初始固定期，但 ARCR 后对非手术治疗有反应的术后僵硬并不常见。在出现僵硬的情况下，关节镜下囊松解可以成功恢复运动范围。ARCR 允许采用延迟活动方案，这对于实现肩袖愈合可能很重要。基于本综述，ARCR 患者术前僵硬的最佳处理方式尚无定论。
IV 级，对 III 级和 IV 级研究的系统评价。
