Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A..
Arthroscopy. 2019 Mar;35(3):979-993. doi: 10.1016/j.arthro.2018.10.126. Epub 2019 Feb 4.
Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario.
In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented.
Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection.
The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation.
Level V, systematic review of Level II, III, IV, and V studies.
术前粘连性肩关节囊炎（AC）和肩袖（RC）同时存在会对治疗产生挑战，因为这两种疾病的干预和康复目标不同。本系统评价的目的是评估关于同时存在 RC 撕裂和术前 AC 的患者的管理和康复的文献，并比较这种常见情况的各种策略的总体临床结果。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，使用预定的标准对上述患者人群的研究进行了两次重复的数据库（MEDLINE、Embase 和 PubMed）搜索和筛选。给出了描述性统计数据。
952 项研究中有 17 项研究共涉及 662 个肩部，平均年龄 59.6±3.5 岁，57.9%为女性患者，平均随访时间为 18.6 个月。包含囊松解（CR）（86.1%）和麻醉下手法松解（MUA）（33.1%）是 RC 修复最常见的合并治疗。在所有研究中，术前美国肩肘外科医生评分（ASES）的平均值范围从 29.0 到 61.3，视觉模拟评分（疼痛）的平均值范围从 5.3 到 8.0，常数评分的平均值范围从 18.0 到 48.0。术后平均美国肩肘外科医生评分（ASES）的平均值范围从 76.9 到 92.0，视觉模拟评分（疼痛）的平均值范围从 0.3 到 2.5，常数评分的平均值范围从 72.6 到 93.2。术后康复包括术后立即使用外展支具和被动活动度，持续 5.0 周和 5.3 周，然后在第 5.3 周开始主动活动度，第 10.9 周开始力量训练。术后并发症包括僵硬、RC 再撕裂、不稳定、肩胛盂骨折和浅表感染。
本系统评价的结果支持对退行性 RC 撕裂和同时存在的 AC 患者采用 RC 修复联合 MUA、CR 或 MUA 和 CR 联合治疗。无论治疗方式如何，加速术后康复方案都有助于预防术后 AC 持续存在，并且可以在这种情况下安全使用，而不会与单独接受 RC 修复和保守康复的患者相比显著增加并发症发生率。
等级 V，对等级 II、III、IV 和 V 研究的系统评价。
