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No benefits observed for delayed surgical repair of torn rotator cuff
Patients who had stiffness showed better repair integrity than patients without stiffness and both groups' overall range of motion was similar.
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LAS VEGAS — Rotator cuff repair with glenohumeral joint capsule release demonstrated good outcomes, indicating there is no need to delay rotator cuff tear repair surgery to allow stiffness to heal, according to a speaker at the American Orthopaedic Society for Sports Medicine Specialty Day Meeting, here.
“In the past, many surgeons have elected to wait until stiffness has resolved in patients with rotator cuff tears and stiffness, for fear of making the shoulder worse,” George A. C. Murrell, MD, PhD, told Orthopaedics Today Europe. “This research shows the opposite is true: if you repair the rotator cuff in the presence of stiffness, the chances of getting a good outcome are much greater.”
Results showed retear rates at 2 years of 0% in patients with shoulder stiffness and 20% in patients without shoulder stiffness after rotator cuff repairs.
Stiffness vs. non-stiffness
The study’s lead author, Jordan McGrath, Murrell and colleagues retrospectively compared 170 patients who had rotator cuff repair with 25 patients who had rotator cuff repair and arthroscopic capsular release for shoulder stiffness, using modified L’Insalata Questionnaires to evaluate patient-ranked pain and function scores preoperatively, intraoperatively and postoperatively at 1 week, 6 weeks, 12 weeks, 6 months and 2 years. Range of motion, strength and the presence of signs of impingement were also recorded.
Prior to surgery, the stiffness group had more difficulty performing overhead activities compared to the non-stiffness group. However, at the 6-month and 2-year follow-ups the stiffness group significantly recovered the ability to perform overhead activities at a similar level of difficulty as the non-stiffness group. Both groups improved significantly from their respective preoperative levels.
The non-stiffness group expressed having better overall shoulder function prior to surgery than the stiffness group, however, this was not significantly different postoperatively. At the 2-year follow-up both groups improved significantly.
Retear occurrences by group
Utilizing ultrasound, the researchers assessed rotator cuff integrity and recorded size, location and thickness of any tears observed.Lead author McGrath, who presented the results at the meeting, said the most interesting result of the study was “at 6 months, 14% of non-stiffness patents had a retear and again at 2 years it was 20%.”
“Our cohort of patients who had a capsular release [for stiffness] and a rotator cuff repair had a healing rate of 100% at 6 months and at 2 years, i.e., no retears,” Murrell said. “This is the first study I have done, and I suspect that anyone else has done, where there were no retears after rotator cuff repair.”
Forward flexion, abduction and external rotation range of motion were similar in both groups, but range of internal rotation was superior in the non-stiffness cohort, according to the researchers. – by Monica Jaramillo
- Reference:
- McGrath J, et al. Paper #13. Presented at: American Orthopaedic Society for Sports Medicine Specialty Day Meeting; March 28, 2015; Las Vegas, USA.
- For more information:
- Jordan McGrath and George A. C. Murrell, MD, PhD, can be reached at Department of Orthopaedic Surgery, Orthopaedic Research Institute, University of New South Wales, St. George Hospital Campus, Education & Research Centre 4-10 South St. Kogarah, Sydney, New South Wales, 2217 Australia. McGrath’s email: jmcgrathunsw@gmail.com. Murrell’s email: murrell.g@ori.org.au.
Disclosures: McGrath reports no relevant financial disclosures. Murrell reports he receives royalties and financial support from Novan, is a paid consultant for ArthroCare and receives research support from ArthroCare and Arthrex.
Perspective
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Pietro Randelli, MD
I read with interest the study by McGrath and colleagues. They stated that in individuals with concomitant rotator cuff tears and stiffness, the re-rupture rate is 0% at 2 years. They compared this group to controls without preoperative stiffness who had a 20% re-rupture rate. Unfortunately, these data, while interesting, are misleading because of some methodological flaws in this study. First of all, this is not a randomized controlled trial but a retrospective study of a small number of patients, and there were only 25 patients in the treatment group. The two groups also had different rehabilitation, especially in the early phase. Finally, patients in the group with stiffness group had a higher proportion of partial cuff tears (72%) compared with the control group (44%), and it is well known the smaller the cuff tear, the better the healing rate. In conclusion, I suggest all shoulder surgeons avoid scheduling surgery for patients with stiff shoulders until further prospective studies clarify this matter.
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