Bhatia Sanjeev, Mather Richard C, Hsu Andrew R, Ferry Amon T, Romeo Anthony A, Nicholson Gregory P, Cole Brian J, Verma Nikhil N
Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Indian J Orthop. 2013 Mar;47(2):143-9. doi: 10.4103/0019-5413.108892.
Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair.
Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24-70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2-36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1-43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test.
Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110-180° SD 22.3°), and ERS improved to 58.9°, (range 15-90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion.
Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair.
肩袖修复手术是世界上最常开展的手术之一，但关于肩袖修复术后关节纤维化最佳管理的指导文献有限。本研究的目的是报告关节镜下关节囊松解、粘连松解、麻醉下手法松解以及积极物理治疗对肩袖修复术后顽固性僵硬患者的治疗结果。
29例肩袖修复术后出现顽固性关节纤维化的患者纳入研究，其中关节镜手术修复者占62%，开放手术修复者占28%，小切口开放手术修复者占10%。初次肩袖修复手术时的平均年龄为49.8岁（范围24 - 70岁）。16例患者（55%）涉及工伤赔偿。从初次手术到粘连松解的平均时间为9.7个月（范围4.2 - 36.2个月），从粘连松解到最近一次随访的平均时间为18.2个月（范围4.1 - 43.7个月）。18例患者（62%）采用美国肩肘外科医师评分（ASES）、视觉模拟评分（VAS）、单项评估数值评定（SANE）和简易肩关节测试（SST）进行术后评估，13例患者（45%）进行了活动范围（ROM）、握力计力量测试和Constant - Murley评分。采用学生t检验进行统计分析。
在关节镜下粘连松解术前，平均前向主动抬高（FE）为103.8°（范围60 - 145°，标准差26.3），侧方外旋（ERS）为25.3°（范围5 - 70°，标准差15.1°）。术后，在最近一次随访时，FE显著提高到158.3°（范围110 - 180°，标准差22.3°），ERS提高到58.9°（范围15 - 90°，标准差18.6°）。涉及工伤赔偿的患者ASES、VAS和SANE评分较低，但在活动方面无统计学显著差异。
关节镜下关节囊松解、粘连松解和麻醉下手法松解是治疗肩袖修复术后持续性僵硬的一种安全、可靠的方法。
