Clin Orthop Surg.  2011 Mar;3(1):55-61. 10.4055/cios.2011.3.1.55.

Effectiveness of Subacromial Anti-Adhesive Agent Injection after Arthroscopic Rotator Cuff Repair: Prospective Randomized Comparison Study

• Oh CH
• Oh JH
• Kim SH
• Cho JH
• Yoon JP
• Kim JY

• KMID: 999461
• DOI: http://doi.org/10.4055/cios.2011.3.1.55

Abstract

BACKGROUND
Arthroscopic rotator cuff repair generally has a good clinical outcome but shoulder stiffness after surgery due to subacromial adhesion is one of the most common and clinically important complications. Sodium hyaluronate (HA) has been reported to be an anti-adhesive agent in a range of surgical procedures. However, there are few reports of the outcomes of arthroscopic rotator cuff repair of the shoulder. This study examined whether a subacromial injection of HA/carboxymethylated cellulose (CMC) affected the postoperative shoulder stiffness and healing of rotator cuff repair, as well as the safety of an injection.
METHODS
Between January 2008 and May 2008, 80 consecutive patients with arthroscopic rotator cuff repair were enrolled. The patients were assigned randomly to the HA/CMC injection group (n = 40) or control group (n = 40). All patients were evaluated using the visual analog scale (VAS) for pain, passive range of motion at 2, 6 weeks, 3, 6, 12 months after surgery, and the functional scores at 6, 12 months postoperatively. Cuff healing was also evaluated using CT arthrography or ultrasonography at 6 or 12 months after surgery.
RESULTS
The HA/CMC injection group showed faster recovery of forward flexion at 2 weeks postoperatively than the control group but the difference was not statistically significant (p = 0.09). There were no significant difference in pain VAS, internal rotation, external rotation and functional scores between two groups at each follow-up period. The functional scores improved 6 months after surgery in both groups but there were no differences between the two groups. The incidence of unhealed rotator cuff was similar in the two groups. There were no complications related to an injection of anti-adhesive agents including wound problems or infections.
CONCLUSIONS
A subacromial injection of an anti-adhesive agent after arthroscopic rotator cuff repair tended to produce faster recovery in forward flexion with no adverse effects on cuff healing. However, its anti-adhesive effects after rotator cuff repair should be considered carefully with further studies.

Keyword

Rotator cuff repair; Sodium hyaluronate; Anti-adhesive agent; Shoulder stiffness

MeSH Terms

Adult
Aged
Arthroscopy/*adverse effects/*methods
Carboxymethylcellulose Sodium
Drug Carriers
Female
Humans
Hyaluronic Acid/adverse effects/*therapeutic use
Male
Middle Aged
Pain
Prospective Studies
Range of Motion, Articular
Recovery of Function
Rotator Cuff/injuries/*surgery
Shoulder Joint/physiology
Tissue Adhesions/*prevention & control
Treatment Outcome
Viscosupplements/adverse effects/*therapeutic use

Figure

• 

  Fig. 1 Preoperative pain visual analog scale (VAS) was not different between two groups and improved continuously throughout follow-up period. Significant pain improvement was found at two weeks postoperatively, and between postoperative (PO) 3 and 6 months in both groups. Range bars show the standard errors. *p < 0.05.

• 

  Fig. 2 Forward flexion (FF) showed no difference at preoperative period, but faster recovery was demonstrated in injection group (146.47° ± 17.26°) than in control group (137.65° ± 24.69°) at two weeks postoperatively (*p = 0.09). Significant improvement of FF within groups was found between postoperative (PO) 6 weeks and 3 months, and postoperative 3 months and 6 months in both groups (**p < 0.05).

• 

  Fig. 3 External rotation (ER) at side showed no significant statistical difference between two groups at serial follow-ups. Significant improvement of ER within groups was found between postoperative (PO) 6 weeks and 3 months (*p < 0.05) and postoperative 3 months and 6 months in control groups (**p < 0.05).

• 

  Fig. 4 Internal rotation at back showed no significant statistical difference between two groups at serial follow-ups. Significant improvement of internal rotation (IR) within groups was found between postoperative (PO) 6 weeks and 3 months and postoperative 3 months and 6 months in both groups (*p < 0.05). 5: level of 5th thoracic vertebra, 13: level of 1st lumbar vertebrae, 17: level of 5th lumbar vertebrae, 18: any level below the sacral vertebrae.

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  Fig. 5 Constant score demonstrated no statistical difference between two groups at serial follow-ups. Significant improvement of constant score within groups was found between preoperative check and postoperative (PO) 6 months in both groups (*p < 0.05).

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  Fig. 6 American Shoulder and Elbow Surgeons (ASES) score was not different between two groups at serial follow-ups. Significant improvement of ASES score within groups was found between preoperative check and postoperative (PO) 6 months in both groups (*p < 0.05).

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