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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.
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.
The purpose of this study was to investigate the association between smoking status and postoperative complications within 30 days of arthroscopic rotator cuff repair (ARCR).
The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients who underwent ARCR from 2015 to 2017. Smokers were defined as patients who reported smoking cigarettes in the year prior to rotator cuff repair. Patients who used chewing tobacco, cigars, or electronic cigarettes were not included in the smoking cohort. Postoperative complications were reported within 30 days of the procedure. Multivariate logistic regression was performed to investigate the relationship between smoking status and postoperative complications.
There were 18,594 patients included in this study. Of these patients, 2834 (15.2%) were current smokers. Smokers were more likely to be men, to be aged < 65 years, and to have a body mass index <30. Smokers were also more likely to have chronic obstructive pulmonary disease, to be functionally dependent, and to have an American Society of Anesthesiologists (ASA) class ≥ 3. After adjustment for all significantly associated patient demographic characteristics and comorbidities, smoking was identified as a significant predictor of surgical complications (odds ratio [OR], 1.955;
= .022), return to the operating room (OR, 2.547;
= .003), readmission (OR, 1.570;
= .014), and sepsis or septic shock (OR, 4.737;
= .021). Smoking was not a significant predictor of medical complications (OR, 1.105;
= .687) or surgical-site infections (OR, 1.216;
= .713).
Smoking may be a risk factor for surgical complications, readmission, and sepsis or septic shock within 30 days of ARCR.
Smoking may be a risk factor for surgical complications, readmission, and sepsis or septic shock within 30 days of ARCR.
Degenerative signs on shoulder radiographs, including spur formation and narrow acromiohumeral intervals (AHIs), have been recognized as indicative of atrophic and fat-infiltrated rotator cuff muscles. Past studies have demonstrated that patients with poor quality muscles are prone to retraction of the supraspinatus tendon and failure to repair. selleck kinase inhibitor However, the association between radiographic signs and tendon retraction has never been elucidated in previous literature. The present study aimed to investigate the association between the degenerative signs on shoulder radiographs and the severity of supraspinatus retraction.
Images of 67 individuals, who had undergone an arthroscopic rotator cuff repair, were retrospectively reviewed. The greater tuberosity (GT) morphology, subacromial spur, AHI, and acromial thickness were evaluated on the radiographs, whereas the retraction of the supraspinatus tendon was assessed via an MRI in accordance with the Patte classification. Simple regression analyses between the was highly specific (sensitivity 27.3% / specificity 91.1%) for advanced supraspinatus retraction.
The presence of a radiographic GT spur, narrow AHI, and subacromial spur indicated advanced retraction of the supraspinatus tendon. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended.
The presence of a radiographic GT spur, narrow AHI, and subacromial spur indicated advanced retraction of the supraspinatus tendon. When patients with clinical suspicion of rotator cuff tear present with combinations of these radiographic signs, a prompt MRI examination and a referral to a shoulder specialist are recommended.
The greater tuberosity angle (GTA) is a newly described radiological parameter identified in a 2018 study by Cunningham etal that sought to investigate the effect of GT morphology on cuff tears. Increased GTA has been conceptualized to affect rotator cuff pathology through both extrinsic and intrinsic mechanisms. GTA > 70° was highly predictive of a degenerative rotator cuff tear. This study seeks to examine if increased GTA predicts for worse functional outcomes 2 years postoperatively after arthroscopic rotator cuff repair.
Between May 2010 and December 2016, 169 patients who underwent arthroscopic rotator cuff repair with subacromial decompression were included in this study. GTA was measured on preoperative radiographs. These patients were evaluated preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Outcomes were assessed with the Visual Analog Scale Pain score, Constant Shoulder Score, and the Oxford Shoulder Score. Power analysis was performed based on the minimal clinically important difference of the Constant Shoulder Score.