Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
ANZ J Surg. 2023 Dec;93(12):2958-2963. doi: 10.1111/ans.18760. Epub 2023 Nov 12.
Postoperative stiffness affects up to 20% of patients following arthroscopic rotator cuff repair. Recent evidence indicates that early postoperative stiffness may associated with lower retear rates. This study aimed to identify the independent predictors of early postoperative stiffness.
A retrospective cohort study of 1526 rotator cuff repairs was performed. Range of motion at 6-week postop was used to identify stiff patients. Stiffness was defined as external rotation <27.5 or forward flexion <145 . Multiple logistic regression analysis was used to identify the independent predictors of 6-week stiffness.
The independent predictors for external rotation stiffness at 6-week postop were more recent cases (Wald = 60), restricted preoperative external rotation (Wald = 36), younger age (Wald = 21) and poorer surgeon-ranked tissue quality (Wald = 15). The independent predictors for forward flexion stiffness were more recent cases (Wald = 101), restricted preoperative forward flexion (Wald = 16) and external rotation (Wald = 13) and female patients (Wald = 12). All patients that developed early postoperative stiffness had recovered range of motion by 6 months to preoperative levels (P < 0.0001). A significantly greater proportion of younger patients (40-49) developed postoperative stiffness when compared to older patients aged 50-59 (P < 0.0062), 70-79 (P < 0.0126) and 80-89 (P < 0.004). Patients that retore had significantly greater average 6-week postoperative range of motion.
Patients earlier in the study were found to have greater postoperative range of motion, which coincided with a more aggressive rehabilitation program with less immobilization. Thus, the data supports the hypothesis that a temporary period of shoulder stiffness facilitates tendon repair and ultimately a better outcome post rotator cuff repair.
关节镜肩袖修复术后僵硬影响多达 20%的患者。最近的证据表明，早期术后僵硬可能与较低的再撕裂率相关。本研究旨在确定早期术后僵硬的独立预测因素。
对 1526 例肩袖修复术进行回顾性队列研究。术后 6 周的关节活动度用于确定僵硬患者。僵硬定义为外旋<27.5 或前屈<145°。多因素逻辑回归分析用于确定 6 周僵硬的独立预测因素。
术后 6 周外旋僵硬的独立预测因素是最近的病例（Wald=60）、术前外旋受限（Wald=36）、年龄较小（Wald=21）和较差的外科医生分级组织质量（Wald=15）。前屈僵硬的独立预测因素是最近的病例（Wald=101）、术前前屈受限（Wald=16）和外旋受限（Wald=13）以及女性患者（Wald=12）。所有发生早期术后僵硬的患者在 6 个月时均恢复了术前的关节活动度（P<0.0001）。与 50-59 岁（P<0.0062）、70-79 岁（P<0.0126）和 80-89 岁（P<0.004）的老年患者相比，40-49 岁的年轻患者发生术后僵硬的比例明显更高（P<0.0001）。再撕裂的患者术后 6 周的平均关节活动度明显更大。
研究早期的患者发现术后关节活动度更大，这与更积极的康复方案相符，固定时间更少。因此，数据支持这样一种假设，即暂时的肩部僵硬有助于肌腱修复，最终使肩袖修复后获得更好的结果。
