Clin Orthop Surg.  2019 Jun;11(2):192-199. 10.4055/cios.2019.11.2.192.

Preoperative Pain Control in Arthroscopic Rotator Cuff Repair: Does It Matter?

• Tonotsuka
• Sugaya H
• Takahashi
• Kawai N
• Sugiyama H
• Marumo K

• KMID: 2445055
• DOI: http://doi.org/10.4055/cios.2019.11.2.192

Abstract

BACKGROUND
The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR).
METHODS
A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A−), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups.
RESULTS
The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A− (10/91, 11.0%) and group B (7/91, 7.7%, p < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A− (53.9 ± 11.9) and group B (62.3 ± 11.2, p < 0.001 for both), and it was significantly lower in group A− than in group B (p = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A− (97.6 ± 5.4) and group B (99.0 ± 2.5, p < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A− and group B (p = 0.242).
CONCLUSIONS
Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.

Keyword

Shoulder; Rotator cuff injury; Arthroscopy; Rehabilitation; Pain management

Figure

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  Fig. 1 Flowchart of patient enrollment and follow-up.

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  Fig. 2 Comparison of forward flexion (FF) preoperatively and at 3 and 24 months after surgery. FF value at 24 months after surgery is significantly higher in group A− and group B than that in group A+ with no significant difference between group A− and group B. Group A+: those who required several corticosteroid injections preoperatively because of refractory RP but the RP persisted, Group A−: those whose RP had disappeared by the time of surgery, Group B: those without RP who did not require any injections, RP: rest pain. *p < 0.05.

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  Fig. 3 Comparison of side-lying external rotation (ER) preoperatively and at 3 and 24 months after surgery. ER value at 24 months after surgery is significantly higher in group A− and group B than that in group A+ with no significant difference between group A− and group B. Group A+: those who required several corticosteroid injections preoperatively because of refractory RP but the RP persisted, Group A−: those whose RP had disappeared by the time of surgery, Group B: those without RP who did not require any injections, RP: rest pain. *p < 0.05.

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