title: Are delayed operations effective for patients with rotator cuff tears and concomitant stiffness? An analysis of immediate versus delayed surgery on outcomes.
abstract: OBJECTIVE
  The purpose of this study was to compare the clinical outcomes of immediate rotator cuff repair with capsular release and those of rotator cuff repair after the stiffness was treated with rehabilitative therapy.
  
  
  METHODS
  Between June 2007 and December 2010, we recruited 63 patients with rotator cuff tears and stiffness. In 33 patients arthroscopic rotator cuff repair was performed with capsular release simultaneously (group I). In 30 patients arthroscopic rotator cuff repair was performed after 6 months of preoperative rehabilitation for stiffness (group II). The American Shoulder and Elbow Surgeons score, Simple Shoulder Test score, Constant score, and visual analog scale score for pain and range of motion (ROM) were assessed at the start of the study; at 3, 6, and 12 months; and at the last visit. The postoperative cuff tendon integrity was assessed between 6 and 12 months using magnetic resonance or ultrasound images.
  
  
  RESULTS
  There were no significant differences in preoperative demographic data between the groups (P > .05). The mean follow-up period was 21.54 months. After treatment, there was significant improvement in ROM and functional scores in both groups, as measured at the last follow-up (P < .05). No statistical differences were found in clinical scores and ROM at the last follow-up (P > .05). On assessment of the magnetic resonance or ultrasound images taken 6 to 12 months postoperatively, the retear rate for the repaired cuff tendon in each group was 12.1% in group I and 13.4% in group II.
  
  
  CONCLUSIONS
  In the treatment of rotator cuff tears with stiffness, satisfactory results can be achieved either by repairing the tear with simultaneous capsular release or by waiting to perform the repair after preoperative rehabilitation for stiffness. Because a delayed rotator cuff repair after improving ROM offered no clear advantage over an immediate operation, we recommend surgically treating rotator cuff tears with concomitant stiffness early using a simultaneous capsular release method to save time and to avoid unnecessary rehabilitation.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Yang-Soo
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, South Korea. Electronic address: hyojin1229@gmail.com.
authors.forename: Hyo-Jin
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: In
authors.initials: I
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Jin-Hyung
authors.initials: JH
authors.lastname: Im
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Kwang-Sun
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Wonkwang University of School of Medicine, Gunpo, South Korea.
authors.forename: Seung-Bin
authors.initials: SB
authors.lastname: Lee
mesh_terms: D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D057913:Joint Capsule Release; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000503:physiopathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000601:surgery*; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome