{"title":"关节镜下肩袖修复术后早期僵硬:肩袖修复术的术后早期僵硬度:与术前功能评分、疼痛程度和一年预后的关系 -肩袖修复术的预后与僵硬度和疼痛有关。","authors":"","doi":"10.1016/j.arthro.2024.01.038","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>To assess whether early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in patients who undergo arthroscopic rotator cuff repair (ARCR).</p></div><div><h3>Methods</h3><p>This was a single-center retrospective study; 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over 4 years were considered. Patients with at least 1 year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at 3 months’ postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months’ postoperatively. Stiffness, retear rates, and tendon integrity were assessed via magnetic resonance imaging at 12 months.</p></div><div><h3>Results</h3><p>Of 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (<em>P</em> = .013/.014) and greater VAS score (<em>P</em> = .034). At 3 months, this group showed lower ROM and functional scores (<em>P</em> < .001), persisting at 6 and 12 months (except internal rotation) (<em>P</em> < .001). Their 12-month VAS score was greater (<em>P</em> = .024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (<em>P</em> = .035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (<em>P</em> = .032). Minimal clinically important difference analysis indicated ROM changes but limited functional score changes in the 2 groups.</p></div><div><h3>Conclusions</h3><p>This study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and greater pain levels. Shoulder stiffness at 3 months’ post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective comparison study.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S074980632400094X/pdfft?md5=b3e87ca51a0fc5988bbf99527615cd51&pid=1-s2.0-S074980632400094X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair Correlates With Improved Tendon Healing\",\"authors\":\"\",\"doi\":\"10.1016/j.arthro.2024.01.038\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purpose</h3><p>To assess whether early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in patients who undergo arthroscopic rotator cuff repair (ARCR).</p></div><div><h3>Methods</h3><p>This was a single-center retrospective study; 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over 4 years were considered. Patients with at least 1 year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at 3 months’ postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months’ postoperatively. Stiffness, retear rates, and tendon integrity were assessed via magnetic resonance imaging at 12 months.</p></div><div><h3>Results</h3><p>Of 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (<em>P</em> = .013/.014) and greater VAS score (<em>P</em> = .034). At 3 months, this group showed lower ROM and functional scores (<em>P</em> < .001), persisting at 6 and 12 months (except internal rotation) (<em>P</em> < .001). Their 12-month VAS score was greater (<em>P</em> = .024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (<em>P</em> = .035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (<em>P</em> = .032). Minimal clinically important difference analysis indicated ROM changes but limited functional score changes in the 2 groups.</p></div><div><h3>Conclusions</h3><p>This study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and greater pain levels. Shoulder stiffness at 3 months’ post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective comparison study.</p></div>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S074980632400094X/pdfft?md5=b3e87ca51a0fc5988bbf99527615cd51&pid=1-s2.0-S074980632400094X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S074980632400094X\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S074980632400094X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair Correlates With Improved Tendon Healing
Purpose
To assess whether early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in patients who undergo arthroscopic rotator cuff repair (ARCR).
Methods
This was a single-center retrospective study; 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over 4 years were considered. Patients with at least 1 year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at 3 months’ postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months’ postoperatively. Stiffness, retear rates, and tendon integrity were assessed via magnetic resonance imaging at 12 months.
Results
Of 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (P = .013/.014) and greater VAS score (P = .034). At 3 months, this group showed lower ROM and functional scores (P < .001), persisting at 6 and 12 months (except internal rotation) (P < .001). Their 12-month VAS score was greater (P = .024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (P = .035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (P = .032). Minimal clinically important difference analysis indicated ROM changes but limited functional score changes in the 2 groups.
Conclusions
This study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and greater pain levels. Shoulder stiffness at 3 months’ post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.
期刊介绍:
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.