Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea.
Arthroscopy. 2013 Feb;29(2):290-300. doi: 10.1016/j.arthro.2012.08.023. Epub 2013 Jan 3.
The aims of this study were to determine the incidence of postoperative stiffness after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on outcome.
We included 288 patients (mean age, 59.5 ± 8.4 years) who underwent surgical repair of full-thickness rotator cuff tears. Postoperative range of motion was measured serially 3 months, 6 months, and at least 1 year (mean, 22.8 ± 13.1 months) after surgery. Simultaneously, functional outcome was evaluated using the pain visual analog scale (VAS) and the American Shoulder and Elbow Surgeons (ASES) score, and cuff healing was confirmed by computed tomography arthrography or ultrasonography at least 1 year after surgery (mean, 13.5 ± 2.7 months). We calculated the serial incidence of postoperative stiffness at each follow-up visit, assessed the risk factors for postoperative stiffness at each period, and then evaluated the correlation of stiffness with cuff healing and functional outcome.
The incidence of postoperative stiffness was 18.6% (54/288) at 3 months, 2.8% (8/288) at 6 months, and 6.6% (19/288) at final follow-up. Mean age was higher in the stiffness group at all times (all P < .05). Preoperative stiffness affected postoperative stiffness only at 3 months (P = .04). Larger tear size, higher grade of fatty infiltration (FI), and open or mini-open surgery were correlated with stiffness only at final follow-up (all P < .05). More patients with final postoperative stiffness showed retear (17/19, 89.5%) compared with those without stiffness (49/269, 18.2%, P < .001), and retear was an independent factor for late postoperative stiffness. Pain VAS was higher in the stiffness group at 3 months and final follow-up (all P < .01), and ASES score was lower in the stiffness group only at final follow-up (P = .03).
Old age is an important risk factor for postoperative stiffness throughout the follow-up period. Early postoperative stiffness is affected by preoperative stiffness. However, late postoperative stiffness, especially newly developed stiffness, is closely related to retear and significantly worse functional outcome after surgical repair, even though we could not find the cause-effect relation. When a patient complains about newly developed stiffness in the late postoperative period, retear should be considered.
Level IV, therapeutic case series.
本研究旨在确定肩袖修复术后僵硬的发生率，并评估术后僵硬与其危险因素的关系及其对结果的影响。
我们纳入了 288 例（平均年龄 59.5±8.4 岁）接受全层肩袖撕裂手术修复的患者。术后 3 个月、6 个月和至少 1 年（平均 22.8±13.1 个月）时连续测量术后活动范围。同时，使用疼痛视觉模拟评分（VAS）和美国肩肘外科医生（ASES）评分评估功能结果，并在术后至少 1 年（平均 13.5±2.7 个月）时通过计算机断层关节造影或超声检查确认肩袖愈合。我们计算了每个随访时的术后僵硬发生率，评估了每个时期术后僵硬的危险因素，然后评估了僵硬与肩袖愈合和功能结果的相关性。
术后 3 个月、6 个月和最终随访时的僵硬发生率分别为 18.6%（54/288）、2.8%（8/288）和 6.6%（19/288）。在所有时间点，僵硬组的平均年龄均较高（均 P<.05）。术前僵硬仅在 3 个月时影响术后僵硬（P=0.04）。较大的撕裂尺寸、较高的脂肪浸润（FI）分级和开放或小切口手术仅与最终随访时的僵硬相关（均 P<.05）。与无僵硬组（49/269，18.2%，P<.001）相比，最终术后僵硬组中更多的患者出现肩袖再撕裂（17/19，89.5%），肩袖再撕裂是晚期术后僵硬的独立因素。在 3 个月和最终随访时，僵硬组的疼痛 VAS 评分较高（均 P<.01），而在最终随访时，僵硬组的 ASES 评分较低（P=0.03）。
高龄是整个随访期间术后僵硬的重要危险因素。早期术后僵硬受术前僵硬的影响。然而，晚期术后僵硬，尤其是新出现的僵硬，与肩袖再撕裂密切相关，且术后手术修复的功能结果明显较差，尽管我们尚未找到其因果关系。当患者在术后晚期出现新的僵硬时，应考虑肩袖再撕裂。
IV 级，治疗性病例系列。
