Clinical outcomes of rotator cuff repair with arthroscopic capsular release and manipulation for rotator cuff tear with stiffness: a matched-pair comparative study between patients with and without stiffness.

PURPOSE: To compare clinical outcomes after surgical treatment between rotator cuff tears with and without shoulder stiffness and evaluate the serial changes in pain intensity, functional scores, and range of motion (ROM). METHODS: The study comprised 26 patients with preoperative stiffness (stiff group) and 26 patients without stiffness (non-stiff group). The stiff group underwent arthroscopic or mini-open rotator cuff repair with arthroscopic capsular release and manipulation. The non-stiff group with rotator cuff repair only was matched for age and sex with the stiff group. The visual analog scale (VAS) pain score; University of California, Los Angeles (UCLA) score; American Shoulder and Elbow Surgeons (ASES) score; and ROM were evaluated preoperatively; 3, 6, and 12 months after surgery; and at final follow-up. RESULTS: Both groups had significant improvements in the VAS pain score, UCLA score, ASES score, and ROM at final follow-up. There were no significant differences between the 2 groups regarding VAS pain score, UCLA score, and ASES score at any period after surgery. In the stiff group, mean forward flexion was significantly lower than that in the non-stiff group at 3 months after surgery (143.1° v 154.2°, P = .003). Mean external rotation and internal rotation were significantly lower than those in the non-stiff group at 3 months after surgery (37.9° v 44.2°, P = .043, and 15.8 v 13.9, P < .001, respectively) and 6 months after surgery (49.1° v 57.3°, P = .002, and 13.2 v 12.0, P = .033, respectively). CONCLUSIONS: Overall satisfactory clinical outcomes could be achieved in both the stiff and non-stiff groups, although the stiff group had slower postoperative recovery of ROM until 6 months after surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study, prognosis study.

Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases.

Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.