Analysis of influencing factors of early pain after arthroscopic rotator cuff repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Dongfang ¹ , WANG Fengkun ¹ , YANG Guodong ¹ , GUO Jia ¹ , ZHANG Yingze ² , YU Tengbo ² , SUN Yuerong ² ,  QI Chao ²

1. Qingdao College of Qingdao University, Qingdao Shandong, 266073, P. R. China;
2. Department of Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266103, P. R. China;

Corresponding author：

QI Chao, Email: qichao2002@163.com

Keywords：

Arthroscopy; rotator cuff tear; rotator cuff repair; postoperative pain; visual analogue scale

DOI：

10.7507/1002-1892.202111020

Video：

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Objective To evaluate the influencing factors that affect early pain after arthroscopic rotator cuff repair. Methods A clinical data of 592 patients who met the selection criteria and underwent arthroscopic rotator cuff repair between June 2018 and October 2020 were retrospectively analyzed. There were 239 males and 353 females, with an average age of 58.1 years (range, 32-81 years). Before operation and at 3 days, 6 weeks, and 3 months after operation, the pain degree of patients was evaluated by visual analogue scale (VAS) score; and the patients were divided into no pain or mild pain group and moderate to severe pain group according to the postoperative VAS score. Preoperative and intraoperative related factors were included for univariate analysis, including age, gender, body mass index, preoperative VAS score, history of frozen shoulder, history of hypertension, history of diabetes, history of smoking, affected tendons (supraspinatus, infraspinatus, or subscapularis tendon injury), supraspinatus muscle atrophy, fatty infiltration, operation time, degree of rotator cuff tear, number of anchors, and whether to perform acromioplasty. The influencing factors of postoperative pain were screened; further logistic regression was used to conduct multivariate analysis to screen for risk factors. Results Moderate to severe pain occurred in 440 patients (74.3%) at 3 days after operation, 382 patients (66.2%) at 6 weeks, and 141 patients (23.8%) at 3 months. Multivariate analysis showed that the women, partial-thickness rotator cuff tear, and acromioplasty were risk factors for pain at 3 days after operation (P<0.05); the women, combined with fatty infiltration, partial-thickness rotator cuff tear, and acromioplasty were the risk factors at 6 weeks (P<0.05); and the women, combined with fatty infiltration, and partial-thickness rotator cuff tear were risk factors at 3 months (P<0.05). Conclusion Among patients undergoing arthroscopic rotator cuff repair, women, those with smaller rotator cuff tears, combined with fatty infiltration, and acromioplasty have more severe pain within 3 months after operation, and attention should be paid to postoperative analgesia in these patients management, providing an individualized approach to rehabilitation, and closer follow-up.

Citation： ZHANG Dongfang, WANG Fengkun, YANG Guodong, GUO Jia, ZHANG Yingze, YU Tengbo, SUN Yuerong, QI Chao. Analysis of influencing factors of early pain after arthroscopic rotator cuff repair. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 284-290. doi: 10.7507/1002-1892.202111020 Copy

1.	Rizvi S, Bishop M, Lam PH, et al. Factors predicting frequency and severity of postoperative pain after arthroscopic rotator cuff repair surgery. Am J Sports Med, 2021, 49(1): 146-153.
2.	Cuff DJ, O’Brien KC, Pupello DR, et al. Evaluation of factors affecting acute postoperative pain levels after arthroscopic rotator cuff repair. Arthroscopy, 2016, 32(7): 1231-1236.
3.	Frangiamore S, Dornan GJ, Horan MP, et al. Predictive modeling to determine functional outcomes after arthroscopic rotator cuff repair. Am J Sports Med, 2020, 48(7): 1559-1567.
4.	Hohmann E, Shea K, Scheiderer B, et al. Indications for arthroscopic subacromial decompression. A level Ⅴ evidence clinical guideline. Arthroscopy, 2020, 36(3): 913-922.
5.	Post M, Silver R, Singh M. Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res, 1983, (173): 78-91.
6.	Thigpen CA, Shaffer MA, Gaunt BW, et al. The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2016, 25(4): 521-535.
7.	Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
8.	Godenèche A, Merlini L, Roulet S, et al. Screw removal can resolve unexplained anterior pain without recurrence of shoulder instability after open Latarjet procedures. Am J Sports Med, 2020, 48(6): 1450-1455.
9.	梁达强, 蒯声政, 李瑛, 等. Latarjet 手术治疗肩关节前向脱位中螺钉固定与纽扣固定的生物力学对比分析. 中国修复重建外科杂志, 2020, 34(5): 602-607.
10.	Williams RC, Morris RP, El Beaino M, et al. Cortical suture button fixation vs bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg, 2020, 29(7): 1470-1478.
11.	Balestro JC, Young A, Maccioni C, et al. Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation. J Shoulder Elbow Surg, 2015, 24(5): 711-718.
12.	Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg, 2003, 97(5): 1464-1468.
13.	Razmjou H, Davis AM, Jaglal SB, et al. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord, 2011, 12: 66. doi: 10.1186/1471-2474-12-66.
14.	Gladstone JN, Bishop JY, Lo IK, et al. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med, 2007, 35(5): 719-728.
15.	Dean BJ, Gwilym SE, Carr AJ. Why does my shoulde hurt? A review of the neuroanatomical and biochemical basis of shoulder pain. Br J Sports Med, 2013, 47(17): 1095-1104.
16.	Davidson PA, Rivenburgh DW. Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg, 2000, 9(6): 502-506.
17.	Castropil W, Schor B, Bitar A, et al. Arthroscopic Latarjet: Technique description and preliminary results. Study of the first 30 cases. Rev Bras Ortop (Sao Paulo), 2020, 55(2): 208-214.
18.	Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
19.	Chung SW, Kim JY, Yoon JP, et al. Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity. Am J Sports Med, 2015, 43(3): 588-596.
20.	Hardy A, Sabatier V, Schoch B, et al. Latarjet with cortical button fixation is associated with an increase of the risk of recurrent dislocation compared to screw fixation. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2354-2360.
21.	Valenti P, Maroun C, Wagner E, et al. Arthroscopic Latarjet procedure combined with Bankart repair: A technique using 2 cortical buttons and specific glenoid and coracoid guides. Arthrosc Tech, 2018, 7(4): e313-e320.
22.	Willemot LB, Wodicka R, Bosworth A, et al. Influence of screw type and length on fixation of anterior glenoid bone grafts. Shoulder Elbow, 2018, 10(1): 32-39.
23.	Singh C, Lam PH, Murrell G. Effect of acromioplasty on postoperative pain following rotator cuff repair. HSS J, 2021, 17(2): 150-157.
24.	Shin SJ, Oh JH, Chung SW, et al. The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy, 2012, 28(5): 628-635.
25.	Waterman BR, Newgren J, Gowd AK, et al. Randomized trial of arthroscopic rotator cuff with or without acromioplasty: No difference in patient-reported outcomes at long-term follow-up. Arthroscopy, 2021, 37(10): 3072-3078.
26.	Abrams GD, Gupta AK, Hussey KE, et al. Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty: randomized prospective trial with 2-year follow-up. Am J Sports Med, 2014, 42(6): 1296-1303.

1. Rizvi S, Bishop M, Lam PH, et al. Factors predicting frequency and severity of postoperative pain after arthroscopic rotator cuff repair surgery. Am J Sports Med, 2021, 49(1): 146-153.
2. Cuff DJ, O’Brien KC, Pupello DR, et al. Evaluation of factors affecting acute postoperative pain levels after arthroscopic rotator cuff repair. Arthroscopy, 2016, 32(7): 1231-1236.
3. Frangiamore S, Dornan GJ, Horan MP, et al. Predictive modeling to determine functional outcomes after arthroscopic rotator cuff repair. Am J Sports Med, 2020, 48(7): 1559-1567.
4. Hohmann E, Shea K, Scheiderer B, et al. Indications for arthroscopic subacromial decompression. A level Ⅴ evidence clinical guideline. Arthroscopy, 2020, 36(3): 913-922.
5. Post M, Silver R, Singh M. Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res, 1983, (173): 78-91.
6. Thigpen CA, Shaffer MA, Gaunt BW, et al. The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2016, 25(4): 521-535.
7. Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
8. Godenèche A, Merlini L, Roulet S, et al. Screw removal can resolve unexplained anterior pain without recurrence of shoulder instability after open Latarjet procedures. Am J Sports Med, 2020, 48(6): 1450-1455.
9. 梁达强, 蒯声政, 李瑛, 等. Latarjet 手术治疗肩关节前向脱位中螺钉固定与纽扣固定的生物力学对比分析. 中国修复重建外科杂志, 2020, 34(5): 602-607.
10. Williams RC, Morris RP, El Beaino M, et al. Cortical suture button fixation vs bicortical screw fixation in the Latarjet procedure: a biomechanical comparison. J Shoulder Elbow Surg, 2020, 29(7): 1470-1478.
11. Balestro JC, Young A, Maccioni C, et al. Graft osteolysis and recurrent instability after the Latarjet procedure performed with bioabsorbable screw fixation. J Shoulder Elbow Surg, 2015, 24(5): 711-718.
12. Cepeda MS, Carr DB. Women experience more pain and require more morphine than men to achieve a similar degree of analgesia. Anesth Analg, 2003, 97(5): 1464-1468.
13. Razmjou H, Davis AM, Jaglal SB, et al. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord, 2011, 12: 66. doi: 10.1186/1471-2474-12-66.
14. Gladstone JN, Bishop JY, Lo IK, et al. Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med, 2007, 35(5): 719-728.
15. Dean BJ, Gwilym SE, Carr AJ. Why does my shoulde hurt? A review of the neuroanatomical and biochemical basis of shoulder pain. Br J Sports Med, 2013, 47(17): 1095-1104.
16. Davidson PA, Rivenburgh DW. Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elbow Surg, 2000, 9(6): 502-506.
17. Castropil W, Schor B, Bitar A, et al. Arthroscopic Latarjet: Technique description and preliminary results. Study of the first 30 cases. Rev Bras Ortop (Sao Paulo), 2020, 55(2): 208-214.
18. Boileau P, Gendre P, Baba M, et al. A guided surgical approach and novel fixation method for arthroscopic Latarjet. J Shoulder Elbow Surg, 2016, 25(1): 78-89.
19. Chung SW, Kim JY, Yoon JP, et al. Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity. Am J Sports Med, 2015, 43(3): 588-596.
20. Hardy A, Sabatier V, Schoch B, et al. Latarjet with cortical button fixation is associated with an increase of the risk of recurrent dislocation compared to screw fixation. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2354-2360.
21. Valenti P, Maroun C, Wagner E, et al. Arthroscopic Latarjet procedure combined with Bankart repair: A technique using 2 cortical buttons and specific glenoid and coracoid guides. Arthrosc Tech, 2018, 7(4): e313-e320.
22. Willemot LB, Wodicka R, Bosworth A, et al. Influence of screw type and length on fixation of anterior glenoid bone grafts. Shoulder Elbow, 2018, 10(1): 32-39.
23. Singh C, Lam PH, Murrell G. Effect of acromioplasty on postoperative pain following rotator cuff repair. HSS J, 2021, 17(2): 150-157.
24. Shin SJ, Oh JH, Chung SW, et al. The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy, 2012, 28(5): 628-635.
25. Waterman BR, Newgren J, Gowd AK, et al. Randomized trial of arthroscopic rotator cuff with or without acromioplasty: No difference in patient-reported outcomes at long-term follow-up. Arthroscopy, 2021, 37(10): 3072-3078.
26. Abrams GD, Gupta AK, Hussey KE, et al. Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty: randomized prospective trial with 2-year follow-up. Am J Sports Med, 2014, 42(6): 1296-1303.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of influencing factors of early pain after arthroscopic rotator cuff repair

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