Schneider William R, Trasolini Robert G, Riker Jesse J, Gerber Noam, Ruotolo Charles J
Department of Orthopedics, Nassau University Medical Center, East Meadow, NY, USA.
Department of Orthopedics, Northwell Health, Smithtown, NY, USA.
JSES Int. 2020 Oct 26;5(1):88-92. doi: 10.1016/j.jseint.2020.09.001. eCollection 2021 Jan.
The purpose of this study was to determine the incidence of clinically significant postoperative stiffness after arthroscopic rotator cuff repair and its resolution. The study also sought to determine clinical and surgical factors that may be associated with increased rates of postoperative stiffness.
We conducted a level III retrospective review of a consecutive series of arthroscopic rotator cuff repairs. During a 5-year period, the senior author (C.J.R.) performed 150 arthroscopic rotator cuff repairs at our institution. Demographic data, comorbid medical conditions, descriptions of rotator cuff tears (including size and level of retraction), and concomitant surgical procedures were evaluated on their correlation with stiffness. All office visits were reviewed to determine preoperative and postoperative motion. Patients were followed up at 1 week, 3 weeks, 6-8 weeks, 3 months, about 6 months, and 1 year postoperatively.
In our analysis of tear types, we were unable to associate stiffness with the type of tear, the tendon torn, or the number of tendons torn or with whether the tendons were retracted. However, we were able to associate female sex, workers' compensation insurance, and a concomitant biceps procedure with stiffness at several time points. The incidence of stiffness was highest at 12 weeks, with 7.3% of patients presenting with stiffness. The rate of stiffness decreased with continued follow-up. Stiffness was found in 3.3% of patients at 16-24 weeks and in 1.6% of patients at 1 year.
Prolonged physical therapy will result in resolution of stiffness in the vast majority of cases, often obviating the return to the operating room for capsular release and lysis of adhesions or mobilization under anesthesia.
本研究的目的是确定关节镜下肩袖修复术后具有临床意义的僵硬发生率及其缓解情况。该研究还试图确定可能与术后僵硬发生率增加相关的临床和手术因素。
我们对一系列连续的关节镜下肩袖修复术进行了三级回顾性研究。在5年期间，资深作者（C.J.R.）在我们机构进行了150例关节镜下肩袖修复术。评估了人口统计学数据、合并症、肩袖撕裂的描述（包括大小和回缩程度）以及同期手术操作与僵硬的相关性。审查了所有门诊就诊情况以确定术前和术后的活动度。患者在术后1周、3周、6 - 8周、3个月、约6个月和1年进行随访。
在我们对撕裂类型的分析中，我们无法将僵硬与撕裂类型、撕裂的肌腱、撕裂的肌腱数量或肌腱是否回缩联系起来。然而，我们能够将女性、工伤保险以及同期二头肌手术与几个时间点的僵硬联系起来。僵硬发生率在12周时最高，7.3%的患者出现僵硬。随着随访时间的延长，僵硬发生率下降。在16 - 24周时，3.3%的患者出现僵硬，在1年时，1.6%的患者出现僵硬。
在绝大多数情况下，延长物理治疗将使僵硬得到缓解，通常无需返回手术室进行关节囊松解、粘连松解或麻醉下活动。
