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Y. Miyasaka1, J. Kurokawa1, T. Sekiguchi2
1Funabashi Orthopaedic Nishifuna Clinic, Department of Rehabilitation, Chiba, Japan, 2Funabashi Orthopaedic Clinic, Department of Rehabilitation, Chiba, Japan
Background: After arthroscopic rotator cuff repair (ARCR), shoulder joint contracture has an influence on the postoperative outcome. Using multivariate analysis, we examined the factors that affect postoperative passive flexion and external rotation 1 year after ARCR. As a result, passive abduction, passive adduction at the non-specified position of shoulder rotation, the week of adduction limitation disappearance, and the ultrasonographic classification of subscapularis tendon gliding were extracted. The cutoff values were calculated for passive abduction (68 degrees or less), passive adduction at the non-specified position of shoulder rotation (−6 degrees or more), adduction limitation disappearance (10 weeks or more), and ultrasonographic classification (type 4 or more). However, the sensitivity and specificity of each cutoff value remained moderate, and clinically, joint contracture might occur in cases where the values are below the cutoff values for several factors.
Purpose: By comparing the sensitivity and specificity when the values are below multiple cutoff values, we aimed to investigate which factors are more likely to cause joint contracture when they occur at the same time.
Methods: The subjects were 73 patients who underwent ARCR and were followed up to 1 year after surgery, without data loss. The measurement items were passive flexion and passive external rotation for 1 year after surgery, 1-month postoperative passive abduction range of motion, passive adduction at the non-specified position of shoulder rotation, the week of adduction limitation disappearance, and ultrasonographic classification. In the analysis, postoperative 1-month factors were combined to create a cross tabulation, and then, the sensitivity and specificity were calculated.
Results: In the combination of two factors, the highest sensitivity was obtained for the week of adduction limitation disappearance and ultrasonographic classification. The sensitivity and specificity for passive flexion 1 year after surgery were 0.80 and 0.56 and passive external rotation were 0.90 and 0.79, respectively. In the combination of three factors, the highest sensitivity was obtained for the week of adduction limitation disappearance, passive abduction, and ultrasonographic classification. The sensitivity and specificity for passive flexion 1 year after surgery were 0.82 and 0.55 and passive external rotation were 0.88 and 0.75, respectively. In the combination of all postoperative 1-month factors, the sensitivity and specificity for passive flexion 1 year after surgery were 0.76 and 0.52 and passive external rotation were 0.85 and 0.70, respectively.
Conclusion(s): The combination of the week of adduction limitation disappearance and ultrasonographic classification showed the highest sensitivity. In addition, the specificity for the external rotation 1 year after surgery was higher than that for other combinations.
Implications: The evaluation of the week of adduction limitation disappearance and ultrasonographic classification is expected to be used as a screening approach to judge joint contracture in ARCR rehabilitation.
Funding, acknowledgements: There are no financial conflicts to disclose.
Keywords: arthroscopic rotator cuff repair, rehabilitation, contracture
Topic: Musculoskeletal: upper limb
Did this work require ethics approval? Yes
Institution: Funabashi Orthopaedic Hospital
Committee: Funabashi Orthopaedic Hospital Ethics Committee
Ethics number: 2017003
All authors, affiliations and abstracts have been published as submitted.
