Incidence and risk factors for early postoperative stiffness after arthroscopic rotator cuff repair in patients without preoperative stiffness.

The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). Two hundred seventy-four patients who underwent primary ARCR were included. At 3 months after surgery, criteria for shoulder stiffness was set as follows: (1) passive forward flexion < 120˚, or (2) external rotation at side < 30˚. Patients with preoperative stiffness or who underwent additional procedures were excluded. Patients-related, radiological (muscle atrophy and fatty infiltration), and intraoperative (tear size, repair techniques, number of anchors used, and synovitis scores) risk factors were analyzed. Univariate and multivariate analyses were used to identify risk factors for postoperative stiffness. Thirty-nine of 274 patients (14.2%) who underwent ARCR developed postoperative stiffness. Univariate analyses revealed that early postoperative stiffness was significantly associated with diabetes mellitus (p = 0.030). However, radiological and intraoperative factors did not affect postoperative shoulder stiffness (all p > 0.05). Multivariate analyses revealed early postoperative stiffness was significantly associated with diabetes mellitus and timing of rehabilitation (p = 0.024, p = 0.033, respectively). The overall incidence of early postoperative stiffness following isolated ARCR in patients without preoperative stiffness was 14.2%. Diabetes mellitus and timing of rehabilitation were independent risk factors for early postoperative stiffness following ARCR.

Early Clinical Outcomes of Manipulation under Anesthesia for Refractory Adhesive Capsulitis: Comparison with Arthroscopic Capsular Release.

BACKGROUD: The purpose of this study was to compare early clinical outcomes of manipulation under anesthesia (MUA) and arthroscopic capsular release (ACR) in patients with refractory adhesive capsulitis (AC). METHODS: Thirty AC patients who underwent MUA (MUA group) were included. As a control group, thirty AC patients who underwent ACR (ACR group) were matched for age and sex with the MUA group. Visual analog scale (VAS) pain score, American shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM) were evaluated preoperatively and at 3, 6, and 12 months after procedure. RESULTS: Both groups had significant improvements in the VAS pain score, ASES score, and ROM at 12 months after procedure. VAS pain score and ASES score were significantly better in the MUA group than in the ACR group at 3 months after procedure. Mean forward flexion was significantly greater in the MUA group than in the ACR group at 3 months after procedure. Mean external rotation and internal rotation were significantly greater in the MUA group than in the ACR group at 3, 6, and 12 months after procedure. Two patients required additional steroid injections at 3 and 6 months after MUA because of recurrent stiffness with pain. CONCLUSIONS: Compared with ACR, MUA provided equivalent clinical outcomes in the early period after procedure. Our study suggests that MUA is a useful option to be considered as treatment for refractory AC before choosing ACR.

Treatment Strategy for Frozen Shoulder.

Frozen shoulder (FS) is a common shoulder disorder characterized by a gradual increase of pain of spontaneous onset and limitation in range of motion of the glenohumeral joint. The pathophysiology of FS is relatively well understood as a pathological process of synovial inflammation followed by capsular fibrosis, but the cause of FS is still unknown. Treatment modalities for FS include medication, local steroid injection, physiotherapy, hydrodistension, manipulation under anesthesia, arthroscopic capsular release, and open capsular release. Conservative management leads to improvement in most cases. Failure to obtain symptomatic improvement and continued functional disability after 3 to 6 months of conservative treatment are general indications for surgical management. However, there is no consensus as to the most efficacious treatments for this condition. In this review article, we provide an overview of current treatment methods for FS.

Closed reduction and internal fixation of completely displaced and rotated lateral condyle fractures of the humerus in children.

OBJECTIVE: To determine the usefulness of closed reduction and internal fixation as the initial treatment for completely displaced and rotated fractures of the lateral condyle of the humerus in children. DESIGN: Prospective. SETTING: Three Level I trauma centers. PATIENTS: We prospectively studied 24 consecutive completely displaced and rotated lateral condylar fractures of the humerus in children (Jakob Stage 3, 20 boys and four girls) that were treated by three different surgeons working at different hospitals during the same period. INTERVENTION: In 21 fractures, we initially attempted closed reduction and internal fixation; in three, we used open reduction and internal fixation and made no attempt at closed reduction. MAIN OUTCOME MEASUREMENT: We assessed the preoperative degree of displacement and postoperative radiographic quality of closed reduction. Clinical results were graded using the criteria suggested by Hardacre et al. RESULTS: Eighteen of 24 (75%) completely displaced and rotated fractures were reduced within 2 mm of residual displacement using the closed method. Three fractures were treated with open reduction and internal fixation initially and internal fixation because of one surgeon's lack of confidence in closed reduction, because of lack of experience with it, early in the study period. Closed reduction to within 2 mm failed in three fractures, so open reduction and internal fixation was then performed. There were no significant complications such as limited range of motion, pain, osteonecrosis of the trochlea or capitellum, nonunion, malunion, or early physeal arrest. CONCLUSION: Closed reduction and internal fixation is an effective treatment for completely displaced and rotated lateral condyle fractures of the humerus in many children.