Incidence and Risk Factors for Early Postoperative Stiffness after Arthroscopic Rotator Cuff Repair in Patients without Preoperative Stiffness

Abstract Purpose The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). Methods Two hundred seventy-four patients who underwent primary ARCR were included. At 3 months after surgery, criteria for shoulder stiffness was set as follows: 1) passive forward flexion < 120˚, or 2) external rotation at side < 30˚. Patients with preoperative stiffness or who underwent additional procedures were excluded. Patients-related, radiological (muscle atrophy and fatty infiltration), and intraoperative (tear size, repair techniques, number of anchors used, and synovitis scores) risk factors were analyzed. Univariate and multivariate analyses were used to identify risk factors for postoperative stiffness. Results Thirty-nine of 274 patients (14.2%) who underwent ARCR developed postoperative stiffness. Univariate analyses revealed that early postoperative stiffness was significantly associated with diabetes mellitus (p = 0.030). However, radiological and intraoperative factors did not affect postoperative shoulder stiffness (all p > 0.05). Multivariate analyses revealed early postoperative stiffness was significantly associated with diabetes mellitus and timing of rehabilitation (p = 0.024, p = 0.033, respectively).Conclusion The overall incidence of early postoperative stiffness following isolated ARCR in patients without preoperative stiffness was 14.2%. Diabetes mellitus and timing of rehabilitation were independent risk factors for early postoperative stiffness following ARCR.

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Factors Predictive of Healing in Large Rotator Cuff Tears: Is It Possible to Predict Retear Preoperatively?

The American Journal of Sports Medicine ◽

10.1177/0363546518762386 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1693-1700 ◽

Cited By ~ 27

Author(s):

Ho Yeon Jeong ◽

Hwan Jin Kim ◽

Yoon Sang Jeon ◽

Yong Girl Rhee

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Fatty Infiltration ◽

Arthroscopic Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Significant Difference ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Many studies have identified risk factors that cause retear after rotator cuff repair. However, it is still questionable whether retears can be predicted preoperatively. Purpose: To determine the risk factors related to retear after arthroscopic rotator cuff repair and to evaluate whether it is possible to predict the occurrence of retear preoperatively. Study Design: Case-control study; Level of evidence, 3. Methods: This study enrolled 112 patients who underwent arthroscopic rotator cuff repair with single-row technique for a large-sized tear, defined as a tear with a mediolateral length of 3 to 5 cm. All patients underwent routine magnetic resonance imaging (MRI) at 9 months postoperatively to assess tendon integrity. The sample included 61 patients (54.5%) in the healed group and 51 (45.5%) in the retear group. Results: In multivariate analysis, the independent predictors of retears were supraspinatus muscle atrophy ( P < .001) and fatty infiltration of the infraspinatus ( P = .027), which could be preoperatively measured by MRI. A significant difference was found between the two groups in sex, the acromiohumeral interval, tendon tension, and preoperative or intraoperative mediolateral tear length and musculotendinous junction position in univariate analysis. However, these variables were not independent predictors in multivariate analysis. The cutoff values of occupation ratio of supraspinatus and fatty infiltration of the infraspinatus were 43% and grade 2, respectively. The occupation ratio of supraspinatus <43% and grade ≥2 fatty infiltration of the infraspinatus were the strongest predictors of retear, with an area under the curve of 0.908, sensitivity of 98.0%, and specificity of 83.6% (accuracy = 90.2%). Conclusion: In patients with large rotator cuff tears, it was possible to predict the retear before rotator cuff repair regardless of intraoperative factors. The retear could be predicted most effectively when the occupation ratio of supraspinatus was <43% or the fatty infiltration of infraspinatus was grade ≥2. Predicting retear preoperatively may help surgeons determine proper treatment and predict the postoperative prognosis.

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Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/03635465211028980 ◽

2021 ◽

pp. 036354652110289

Author(s):

Laurent Audigé ◽

Soheila Aghlmandi ◽

Cécile Grobet ◽

Thomas Stojanov ◽

Andreas M. Müller ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Prognostic Model ◽

Predictive Accuracy ◽

Arthroscopic Rotator Cuff Repair ◽

Shoulder Abduction ◽

Related Factors ◽

Shoulder Stiffness ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

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Analysis of Risk Factors, Complications, Reoperations, and Demographics Associated With Open and Arthroscopic Rotator Cuff Repair: An Analysis of a Large National Database

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.09.001 ◽

2021 ◽

Author(s):

Richard Danilkowicz ◽

Jay M. Levin ◽

Bryan Crook ◽

Jason S. Long ◽

Alexander Vap

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

National Database ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Large National Database

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Pulmonary Embolism after Arthroscopic Rotator Cuff Repair: A Case Report

Clinics in Shoulder and Elbow ◽

10.5397/cise.2014.17.1.31 ◽

2014 ◽

Vol 17 (1) ◽

pp. 31-35

Author(s):

Ji Yong Gwark ◽

Jin Sin Koh ◽

Hyung Bin Park

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Case Report ◽

Rotator Cuff ◽

Orthopedic Surgery ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Arthroscopic Shoulder Surgery ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Pulmonary embolism (PE) is a serious complication that can occur after orthopedic surgery. Most instances of PE in the orthopedic field have occurred after hip or knee arthroplasties or after fracture surgeries. The occurrence of PE related to arthroscopic shoulder surgery is very rare. We report a case of PE that developed after arthroscopic rotator cuff repair, in which the patient did not show preoperatively any remarkable risk factors for PE. We also review the current literature related to this topic.

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Delamination Does Not Affect Outcomes After Arthroscopic Rotator Cuff Repair as Compared With Nondelaminated Rotator Cuff Tears: A Study of 1043 Consecutive Cases

The American Journal of Sports Medicine ◽

10.1177/0363546518817764 ◽

2019 ◽

Vol 47 (3) ◽

pp. 674-681 ◽

Cited By ~ 8

Author(s):

Jieun Kwon ◽

Ye Hyun Lee ◽

Sae Hoon Kim ◽

Jung Hoon Ko ◽

Byung Kyu Park ◽

...

Keyword(s):

Prognostic Factor ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Fatty Infiltration ◽

Arthroscopic Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Symptom Duration ◽

Negative Prognostic Factor ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Limited information is available regarding the characteristics of delaminated rotator cuff tears as compared with nondelaminated tears. Furthermore, there is conflicting information regarding the effects of delamination on the anatomic healing of repaired cuffs. Purpose: To evaluate the characteristics and anatomic outcomes of delaminated rotator cuff tears in comparison with nondelaminated tears to determine whether delamination is a negative prognostic factor affecting rotator cuff repair outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2010 and 2014, 1043 patients were enrolled in the study to assess the prevalence of delamination. Among them, the findings from 531 patients who underwent magnetic resonance imaging or computed tomographic arthrography at least 1 year after surgery were included to determine whether delamination was a negative prognostic factor affecting the anatomic outcomes of arthroscopic rotator cuff repair. Delamination was assessed intraoperatively and defined by distinguishable edge cleavage tearing or interstitial horizontal gap between the articular and bursal surfaces of the torn tendon. One of 3 repair techniques (modified Mason Allen, single row, or double row) was used according to tear configuration and tendon mobilization. The authors evaluated visual analog scale scores for pain and satisfaction and American Shoulder and Elbow Surgeons scores to quantify clinical outcomes. Results: The incidence of delamination was 42.9% (447 of 1043). As compared with those with nondelaminated tears, patients with delaminated tears were older ( P < .001) and had longer symptom duration ( P = .019), larger tear sizes and retractions ( P < .001 for both), higher grades of fatty infiltration of the rotator cuff muscles (all P < .001), and poorer tendon quality ( P < .001). The overall healing failure rate was 19.0% (101 of 531). In univariate analysis, the rate of healing failure for the repaired cuffs was significantly higher in the delaminated group (delaminated tears, 60 of 238, 25.2%; nondelaminated tears, 41 of 293, 14.0%; P = .001). However, results of subgroup and multivariate analyses showed that the presence of delamination was ultimately not an independent risk factor for the failure of cuff healing. Between the delaminated and nondelaminated groups, there was no significant difference in postoperative functional outcomes. Conclusion: The results suggest that delaminated rotator cuff tears might represent chronic degenerative tears of longer symptom duration, with larger tear sizes and higher grades of fatty infiltration in older patients. It appears that delamination could be a confounding factor, not an independent prognostic factor, affecting rotator cuff healing.

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Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120961406 ◽

2020 ◽

Vol 8 (11) ◽

pp. 232596712096140 ◽

Cited By ~ 1

Author(s):

Chih-Kai Hong ◽

Chao-Jui Chang ◽

Fa-Chuan Kuan ◽

Kai-Lan Hsu ◽

Yueh Chen ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

English Language ◽

Arthroscopic Rotator Cuff Repair ◽

Inclusion Criteria ◽

Level Of Evidence ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Retear of a repaired rotator cuff tendon is a major issue for shoulder surgeons. It is possible that diabetes mellitus (DM) is associated with a greater risk of tendon retear after arthroscopic rotator cuff repair. Purpose: To determine whether patients with DM have a higher tendon retear risk after arthroscopic rotator cuff repair. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the Web of Science, PubMed, and Embase databases. Inclusion criteria were articles written in the English language that included patients undergoing arthroscopic rotator cuff repair surgeries, reported the numbers of patients with and those without DM, and reported the number of rotator cuff retears. Data relevant to this study were extracted and statistically analyzed. Random-effects models were used to generate pooled odds ratio estimates and CIs. Results: A total of 160 studies were identified from the initial search, and 5 of them met the inclusion criteria. A total of 1065 patients (207 patients with DM and 858 patients without DM) were included. The pooled results showed that the patients in the DM group had a significantly higher tendon retear risk than did those in the non-DM group (relative risk, 2.25; 95% CI, 1.14-4.45; P = .02). Conclusion: Patients with DM have a 2.25 times higher risk of tendon retear after arthroscopic rotator cuff repair compared with patients without DM.

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