Arthroscopic treatment of rotator cuff tears with shoulder stiffness: a comparison of functional outcomes with and without capsular release.

Background: In a single arthroscopic surgery for rotator cuff tears with a stiff shoulder, closed manipulation with or without arthroscopic capsular release has been combined with the repair. Few studies have reported functional results after this surgery, and a clinical comparison has not been reported. Purpose: To compare functional outcomes with and without capsular release in arthroscopic treatment of rotator cuff tears with a stiff shoulder. Study Design: Cohort study; Level of evidence, 3. Methods: Among patients who underwent arthroscopic rotator cuff repairs with a concomitant stiff shoulder, 34 patients were treated with either manipulation and arthroscopic capsular release (group A; n=18) or manipulation without capsular release (group B; n = 16). Preoperative mean passive forward flexion was 118 degrees in group A and 117 degrees in group B, whereas external rotation at the side was 28 degrees and 29 degrees, respectively. All patients were evaluated at a minimum 2-year follow-up in terms of visual analog scale for pain, muscle power, range of motion, Constant score, modified American Shoulder and Elbow Surgeons (ASES) shoulder evaluation form, and modified University of California at Los Angeles (UCLA) scores. Results: The mean modified ASES score was 90.3 for group A and 87.7 for group B (P=.086). The mean UCLA scores were 34.3 and 33.0, respectively (P=.247). The 2 groups showed a significant difference in forward flexion and external rotation post-operatively, as group B recovered more slowly. There was no difference in the mean visual analog scale for pain at the last follow-up, but a 13 degrees difference in forward flexion (P<.001) and a 10 degrees difference in external rotation (P =. 001) were seen. Conclusion: Overall satisfactory results could be achieved by either method, whereas rapid recovery and improvement of range of motion could be achieved by using a single arthroscopic repair and concomitant release for patients with rotator cuff tears with stiff shoulder.