Arthroscopic rotator cuff repair has a high rate of patient satisfaction. However, multiple studies have shown that the range of motion (ROM) of the shoulder was limited after the procedure. The shoulder external rotation in adduction was limited more significant in the early stage postoperatively. Coracohumeral ligament release (CHLR) would seem to be a reasonable technique to improve early postoperative stiffness.
To represent a prospective, randomized study to assess the effect of coracohumeral ligament release on shoulder ROM in the arthroscopic rotator cuff repair.
Randomized controlled trial; level of evidence, 1.
75 consecutive patients were randomized to either receive coracohumeral ligament release or not during the surgery of arthroscopic rotator cuff repair. The coracohumeral ligament was released from the base of coracoid in the subcoracoid space. Preoperative visual analog scale (VAS) pain scores, postoperative ROM, and University of California-Los Angeles (UCLA) scores were recorded. Rotator cuffs were sutured and repaired with suture bridge technique. VAS pain scores and the ROM measurements were taken at 1, 2, 3, 4, 5, 6, 9, 12 months postoperatively. The UCLA shoulder scores were assessed at 6, 9, 12 months.
There were no complications. Randomization created comparable groups without significant differences. The VAS scores for the CHLR group were actually lower at month 2, 3, and 4 with statistically significance. The mean degree of external rotation (ER), forward flexion (FF), and Abduction (Ab) in CHLR group were higher than those of control at month 1, 2, 3, 4, and 5. There were no difference of internal rotation between two groups.The UCLA shoulder scores were similar in both groups at baseline, No statistically significant difference was found.
Coracohumeral ligament release before rotator cuff repair shows significant better early postoperative ROM recovery than control. It doesn't increase the surgical time significantly. Longer term follow-up should be proceed to determine the eventual clinical outcome.
Keywords: rotator cuff repair, Coracohumeral ligament release, arthroscopy,