Kim Du-Han, Jeon Jong-Hyuk, Choi Byung-Chan, Cho Chul-Hyun
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea.
World J Clin Cases. 2022 May 26;10(15):5097-5102. doi: 10.12998/wjcc.v10.i15.5097.
Knot impingement as a complication after arthroscopic rotator cuff repair (ARCR) has been suggested as a cause of persistent pain with limited motion. We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion, which was confused with infection.
A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room. Passive range of motion could not be evaluated due to the patient's severe pain. The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder. An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder, and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging. Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils. The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed. Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials. The patient's symptoms subsided immediately after the surgical procedure.
Although the incidence of knot impingement is rare, the possibility of knot impingement after ARCR should be a consideration.
关节镜下肩袖修补术（ARCR）后结撞击作为一种并发症，已被认为是导致持续疼痛和活动受限的原因。我们报告一例ARCR后发生结撞击的患者，该患者主诉急性起病的疼痛伴活动受限，曾被误诊为感染。
一名55岁女性因右肩严重疼痛伴活动受限就诊于我院急诊室。由于患者疼痛剧烈，无法评估被动活动范围。该患者四个月前在当地诊所接受了ARCR，采用缝线桥技术治疗右肩小的冈上肌撕裂。右肩X线平片显示肩峰下表面有侵蚀性改变，磁共振成像显示有中等量的滑液和滑膜增厚伴强化。吸出液分析结果显示白细胞计数为3960，中性粒细胞占90%。关节镜检查显示修复的冈上肌腱愈合，可见松散的缝线和线结，伴有严重的肩峰下滑囊炎。对盂肱关节和肩峰下间隙的炎性组织进行清创，清除所有缝线材料。手术后患者症状立即缓解。
尽管结撞击的发生率很低，但ARCR后发生结撞击的可能性仍应予以考虑。
