A new study found that patients with preoperative stiff shoulders undergoing arthroscopic rotator cuff repair did not, in fact, have better outcomes when the surgeon manipulates the stiff shoulder while under anesthesia prior to the repair.
Does Shoulder Manipulation Actually Improve Rotator Cuff Outcomes?
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#rotatorcufftearSecondary#arthroscopy#manipulationunderanethesia
In the study, “Outcomes of Arthroscopic Rotator Cuff Repair in Stiff Shoulders are Comparable to Non-Stiff Shoulders When Combined With Manipulation Under Anesthesia,” published in the December 2020 issue of the journal Arthroscopy, researchers compared the outcomes of arthroscopic rotator cuff repair in patients with preoperative stiffness to those without.
For the study, 135 patients were prospectively evaluated for 2 years after arthroscopic rotator cuff repair for small to medium-sized rotator cuff tears at a single institution.
The patients were divided into stiff (<100˚ of passive forward flexion) and non-stiff cohorts. The patients in the stiff cohort had manipulation under anesthesia (MUA) before the arthroscopic rotator cuff repair (ARCR) was performed.
Outcomes measured included Visual Analog Scale score, Constant Shoulder Score and Oxford Shoulder Score at the preoperative, 6-, 12-, and 24-month time points. The results of the surgery between the cohorts were then compared.
The researchers reported that 123 of the 135 patients (91.1%) completed the follow-up (46 in the stiff cohort and 77 in the non-stiff cohort).
While there were improvements in the mean Constant Shoulder Score at 6 (mean, 59.87; p < .001) and 12 months (mean, 65.88; p = .021) in the stiff group, there were no detectable differences in the Constant Shoulder Score and Oxford Shoulder Score between the two groups at 6, 12 and 24 months.
The percentage of patients achieving minimal clinically important improvements, however, was higher in the stiff group (97.8%) compared with the non-stiff group (75.3%; p = .001).
The Visual Analog Scale scores, forward flexion and strength in both groups were comparable.
The researchers wrote, “The results of our study showed no significant differences in outcome scores in patients with stiff shoulders who underwent MUA combined with ARCR alone. Therefore, early surgical repair should be considered in patients with rotator cuff tears and concomitant shoulder stiffness.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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