Donuk Omuzu Olan ve Olmayan Hastalarda Artroskopik Rotator Manşet Onarımının Orta Dönem Fonksiyonel Sonuçları: Tek Merkezli Retrospektif Kohort Çalışması

Year 2024, Volume: 46 Issue: 5, 675 - 680, 12.09.2024

Erdi Özdemir , Osman Çömez , Halil Kekeç , Selçuk Korkmazer , Yılmaz Ergişi

https://doi.org/10.20515/otd.1421475

Abstract

Donuk omuzun eşlik ettiği rotator manşet yırtığı (RMY), ortopedistler için zorlu bir durumdur; çünkü RMY'ler sıklıkla ameliyat sonrası korunma gerektiren cerrahi onarımla tedavi edilirken, donuk omuzun tedavisi omuz ekleminin hareket açıklığını yeniden sağlamak için fizik tedavidir. Bu patolojilerin aynı anda ortaya çıkması durumunda ideal tedavi konusunda fikir birliği yoktur. Çalışmanın temel amacı donuk omuz omuz eşlik eden veya etmeyen RMY onarımının orta dönem fonksiyonel cerrahi sonuçlarını karşılaştırmaktır. Ocak 2021 ile Ocak 2023 tarihleri arasında kurumumuzda tam kat RMY sebebi ile artroskopik onarım yapılan hastalar retrospektif olarak incelendi. Hastalar artroskopik onarım sırasında donuk omuzu olan ve olmayanlar olarak iki gruba ayrıldı. Donuk omuzlu hastalara genel anestezi altında manipülasyon yapıldı ve RMY onarımı öncesinde rotator intervalleri radyofrekans ile gevşetildi. Hastaların son kontrollerinde görsel analog ağrı skoru (VAS), ASES, Constant skoru ve University of California Los Angeles (UCLA) skorları karşılaştırıldı. Ortalama 23,9 ± 2,7 ay takip süresine sahip toplam 39 hasta (19 donuk omuz ve 20 donuk omuz olmayan) çalışmaya dahil edildi. Son takipte iki grupta ortalama VAS, ASES, UCLA ve Constant skorlarında istatistiksel fark yoktu. Bu çalışmanın bulguları, donuk omuz patolojisinin ameliyat sırasında ele alınması durumunda, ameliyat öncesi donmuş omuzun artroskopik RMY onarımı üzerinde olumsuz bir etkisinin olmadığını göstermektedir.

Keywords

adeziv kapsülit, omuz artroskopisi, omuz sertliği, rotator kılıf

Mid-Term Functional Outcomes Of Arthroscopic Rotator Cuff Repair In Patients With Or Without Frozen Shoulder: A Single-Center Retrospective Cohort Study

Abstract

Rotator cuff tear (RCT) accompanied by frozen shoulder is a challenge for orthopedic surgeons as RCTs are often treated with surgical repair which need protection of repair, whereas the treatment for frozen shoulder is physical therapy to restore the range of motion of the shoulder joint. There is no consensus for the ideal treatment if those pathologies occur at the same time. The primary aim of the study is to compare the mid-term functional surgical outcomes of RCT repair in patients with or without frozen shoulder. Patients who underwent arthroscopic repair for full-thickness RCT in our institution between January 2021 and January 2023 were retrospectively reviewed. Patients were divided into two groups: with or without frozen shoulder at the time of arthroscopic repair. Patients with frozen shoulder underwent manipulation under general anesthesia and their rotator interval was released with a radiofrequency prior to RCT repair. Patients’ visual analog pain score (VAS), Constant score, ASES score, and University of California Los Angeles (UCLA) scores were compared at their latest follow-up. A total of 39 patients (19 frozen and 20 non-frozen shoulders) with a mean 23.9 ± 2.7 months of follow-up were included in the study. At the latest follow-up, there was no statistical difference in frozen and non-frozen groups in the mean VAS, ASES, UCLA, and Constant scores. The findings of the present study suggest that preoperative frozen shoulder does not have a negative impact on arthroscopic RCT repair, if frozen shoulder pathology is addressed during surgery.

Keywords

adhesive capsulitis, shoulder arthroscopy, shoulder stiffness, rotator cuff

Ethical Statement

The study was approved by Karabük University Noninterventional Clinical Research Ethical Committee (Decision no: 2023/1599, Date: 26.12.2023).

References

• 1. Davey MS, Hurley ET, Carroll PJ, Galbraith JG, Shannon F, Kaar K, et al. Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review. Arthroscopy. 2023;39(2):452-8.
• 2. Griesser MJ, Harris JD, Campbell JE, Jones GL. Adhesive capsulitis of the shoulder: a systematic review of the effectiveness of intra-articular corticosteroid injections. J Bone Joint Surg Am. 2011;93(18):1727-33.
• 3. Tauro JC. Stiffness and rotator cuff tears: incidence, arthroscopic findings, and treatment results. Arthroscopy. 2006;22(6):581-6.
• 4. Cho NS, Rhee YG. Functional outcome of arthroscopic repair with concomitant manipulation in rotator cuff tears with stiff shoulder. Am J Sports Med. 2008;36(7):1323-9.
• 5. Sabzevari S, Kachooei AR, Giugale J, Lin A. One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review. J Shoulder Elbow Surg. 2017;26(8):e252-e8.
• 6. Jeong JY, Shim SB, Hong JH, Im W, Lee SM, Yoo JC. Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med. 2020;8(7):2325967120934449.
• 7. Park HS, Choi KH, Lee HJ, Kim YS. Rotator cuff tear with joint stiffness: a review of current treatment and rehabilitation. Clin Shoulder Elb. 2020;23(2):109-17.
• 8. Zhang K, de Sa D, Kanakamedala A, Sheean AJ, Vyas D. Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes. Arthroscopy. 2019;35(3):979-93.
• 9. Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581.
• 10. Saltzman BM, Zuke WA, Go B, Mascarenhas R, Verma NN, Cole BJ, et al. Does early motion lead to a higher failure rate or better outcomes after arthroscopic rotator cuff repair? A systematic review of overlapping meta-analyses. J Shoulder Elbow Surg. 2017;26(9):1681-91.
• 11. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy. 2008;24(9):983-91.
• 12. Ho WP, Huang CH, Chiu CC, Lee CH, Chen CH, Leu TH, et al. One-stage arthroscopic repair of rotator cuff tears with shoulder stiffness. Arthroscopy. 2013;29(8):1283-91.
• 13. McGrath JP, Lam PH, Tan MT, Murrell GA. The effect of concomitant glenohumeral joint capsule release during rotator cuff repair--a comparative study. J Shoulder Elbow Surg. 2016;25(5):714-22.
• 14. Pandey V, Madi S. Clinical Guidelines in the Management of Frozen Shoulder: An Update! Indian J Orthop. 2021;55(2):299-309.