Glenohumeral Hydrodistension for Postoperative Stiffness After Arthroscopic Primary Rotator Cuff Repair

Abstract

Background: Postoperative stiffness is a known complication after rotator cuff repair (RCR). Glenohumeral hydrodistension (GH) has been a treatment modality for shoulder pathology but has not been used to treat postoperative stiffness after RCR. Purpose/Hypothesis: The purpose of this study was to identify the risk factors for postoperative stiffness after RCR and review outcomes after treatment with GH. Our hypotheses were that stiffness would be associated with diabetes and hyperlipidemia and correlated with the tendons involved and that patients with stiffness who underwent GH would have significant improvement in range of motion (ROM). Study Design: Case series; Level of evidence, 4. Methods: Included were 388 shoulders of patients who underwent primary RCR by a single surgeon between 2015 and 2019. Shoulders with revision RCRs were excluded. Patient characteristics, medical comorbidities, and perioperative details were collected. A total of 40 shoulders with postoperative stiffness (10.3%) received GH injectate of a 21-mL mixture (15 mL of sterile water, 5 mL of 0.5% ropivacaine, and 1 mL of triamcinolone [10 mg/mL]). The primary outcome measure was ROM in forward flexion, internal rotation, external rotation, and abduction. Statistical tests were performed using analysis of variance. Results: Patients with diabetes had significantly decreased internal rotation at final follow-up after RCR as compared with patients without diabetes. GH to treat stiffness was performed most commonly between 1 and 4 months after RCR (60%), and patients who received GH saw statistically significant improvements in forward flexion, external rotation, and abduction after the procedure. Patients with hyperlipidemia had the most benefit after GH. Among those undergoing concomitant procedures, significantly more patients who had open subpectoral biceps tenodesis underwent GH. Patients who underwent subscapularis repair or concomitant subacromial decompression had significant improvement in ROM after GH. Only 1 patient who received GH underwent secondary surgery for resistant postoperative stiffness. Conclusion: Patients with diabetes had increased stiffness. Patients with a history of hyperlipidemia or concomitant open subpectoral biceps tenodesis were more likely to undergo GH for postoperative stiffness. Patients who underwent subscapularis repair demonstrated the most improvement in ROM after GH. After primary RCR, GH can increase ROM and is a useful adjunct for patients with stiffness to limit secondary surgery.

The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review

“…The current systematic review provides an updated incidence of POSS after ARCR based on tear type with one of the largest number of articles and patients to date on the topic of POSS. Knowledge concerning POSS after ARCR is crucial as POSS has been associated with decreased patient satisfaction after surgery, increased cost, and decreased outcomes [1,[4][5][6]. Therefore, the ability to better understand POSS after ARCR is paramount to ideal patient outcomes [6].…”

“…In that systematic review, the incidence of transient POSS was 10% and the incidence of resistant POSS was 3.3% [ 9 ]. The management of POSS after ARCR usually involves conservative treatment options such as oral nonsteroidal anti-inflammatory drugs and physical therapy [ 5 ]. A small number of cases of POSS after ARCR require arthroscopic capsular release [ 5 ].…”

“…The management of POSS after ARCR usually involves conservative treatment options such as oral nonsteroidal anti-inflammatory drugs and physical therapy [ 5 ]. A small number of cases of POSS after ARCR require arthroscopic capsular release [ 5 ]. It is possible that POSS after ARCR might be able to be predicted in patients with risk factors, which could help decrease further complications, additional procedures, and diminished outcomes [ 7 ].…”

“…ARCR is one of the most common surgeries performed by orthopedic surgeons with increasing frequency in recent years [ 2 ]. While ARCR can have various postoperative complications, postoperative shoulder stiffness (POSS) is a postoperative complication that is associated with increased cost and decreased patient outcomes [ 4 , 5 ]. Furthermore, POSS has been reported as a common complication after ARCR in the literature [ 1 , 2 ].…”

Factors Affecting Postoperative Rehabilitation Therapy Utilization After Arthroscopic Rotator Cuff Repair: An Epidemiological Analysis

“…Postoperative complications from ARCR cause a significant burden on patients and clinicians alike [1]. A common postoperative complication after ARCR is postoperative shoulder stiffness (POSS), which can result in increased healthcare costs and unfavorable patient outcomes [6][7][8][9]. The incidence of POSS is highly variable and ranges from 2% to 28% in the literature [4,10,11].…”