The rotator cuff tendon is known to exert a shear force between the superficial and deep layers. Owing to this characteristic, separate repair of delaminated rotator cuff tears has been introduced for the restoration of the physiological biomechanics of the rotator cuff. However, whether conventional en masse repair or separate repair is superior is controversial in terms of outcomes. To compare clinical outcomes between conventional en masse repair and separate double-layer double-row repair for the treatment of delaminated rotator cuff tears. Randomized controlled study; Level of evidence, 2. Between August 2007 and March 2014, a total of 82 patients who underwent arthroscopic rotator cuff repair of a delaminated tear were enrolled and randomized into 2 groups. In group 1 (n = 48), arthroscopic conventional en masse repair was performed. In group 2 (n = 34), separate double-layer double-row repair was performed. The American Shoulder and Elbow Surgeons score, Constant score, Simple Shoulder Test score, and visual analog scale (VAS) score for pain and range of motion (ROM) were assessed before surgery; at 3, 6, and 12 months after surgery; and at the last follow-up visit. Magnetic resonance imaging (MRI) was performed at 12 months postoperatively to examine the retear rate and pattern. There was no significant difference between groups in the preoperative demographic data, including patient age, sex, symptom duration, tear size, and functional scores (P > .05). The mean follow-up period was 25.9 ± 1.2 months. Significant improvements in functional and pain scores were observed in both groups at the last follow-up visit. However, no significant differences in functional scores and ROM were found between the 2 groups at each time point, except that group 2 had significantly lower VAS pain scores (P < .05) at 3, 6, and 12 months postoperatively. Eight (17%) of 48 patients in group 1 and 6 (18%) of 34 patients in group 2 showed retears on MRI at 12-month follow-up (P > .05). Both conventional en masse repair and separate double-layer double-row repair were effective in improving clinical outcomes in the treatment of delaminated rotator cuff tears. Lower pain scores were seen in patients who underwent separate double-layer double-row repair.

Patients with partial-thickness rotator cuff tears (PTRCTs) can be treated nonoperatively and/or undergo operative treatment, but the ideal time for surgical intervention is unclear. The purpose is to compare the results of immediate arthroscopic rotator cuff repair with repair after 6 months of nonoperative care of PTRCTs involving more than 50% of the tendon thickness. Randomized controlled trial; Level of evidence, 2. The authors prospectively randomized and analyzed 78 consecutive patients diagnosed with either isolated bursal-side or articular-side PTRCTs (supraspinatus only). Group 1 (n = 44) received immediate rotator cuff repair. Group 2 (n = 34) received delayed rotator cuff repair after 6 months of nonoperative treatment. The American Shoulder and Elbow Surgeons (ASES) Score, Constant score, visual analog scale (VAS) for pain, and range of motion at initial visit; months 3, 6, and 12 postoperatively; and the last visit after 24 months were used for the evaluation. Cuff integrity was assessed with magnetic resonance imaging at 12 months postoperatively. There were no significant differences in age, sex (18/26 vs 13/21, male/female), symptom duration, composition of PTRCTs, or clinical outcomes between groups 1 and 2 (P > .05). In group 2, 10 patients voluntarily dropped out from the study due to improvement of symptoms during the 6 months of preoperative nonoperative treatment. The mean follow-up period in groups 1 and 2 was 31.9 ± 1.5 months and 37.0 ± 2.2 months, respectively. At the end of the study, both groups showed significant improvements in terms of functional scores and pain VAS scores compared with the initial period. There were no significant differences between the 2 groups, except for lower pain VAS score and higher ASES Score in group 2 at 6 months postoperatively. At 12 months postoperatively, 1 patient from group 1 and 2 patients from group 2 experienced a retear. Both immediate surgical repair and delayed repair after nonsurgical care for PTRCTs were effective in improving clinical outcomes, and there was a very low incidence of retears in both groups. However, at 6 months postoperatively, superior functional outcomes were observed in the delayed repair group compared with the immediate repair group. A trial period of preoperative nonsurgical care is reasonable, and immediate surgical repair is not crucial for the treatment of PTRCT.

Arthroscopic capsular release is an effective treatment for shoulder stiffness, yet its extent is controversial. To compare the clinical outcomes of arthroscopic capsular release in patients with and without posterior extended capsular release for shoulder stiffness. Randomized controlled trial; Level of evidence, 1. Between January 2008 and March 2011, 75 patients who underwent arthroscopic capsular release for shoulder stiffness were enrolled and randomized into 2 groups. In group I (n = 37), capsular release was performed, including release of the rotator interval and anterior and inferior capsule. In group II (n = 38), capsular release was extended to the posterior capsule. The American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog scale for pain, and range of motion (ROM) were used for the evaluation before surgery and at 3, 6, and 12 months after surgery and at the last follow-up. Preoperative demographic data of age, sex, symptom duration, and clinical outcomes showed no significant differences (P > .05). The average follow-up was 18.4 months. Both groups showed significantly increased ROM at the last follow-up compared with preoperative ROM (P < .05). At the last follow-up, no statistical differences were found (P > .05) between groups I and II in American Shoulder and Elbow Surgeons score (91.3 vs 79.5), Simple Shoulder Test (83.3 vs 83.3), and visual analog scale (1.5 vs 2.2). There were also no statistical differences between the 2 groups at the last follow-up (P > .05) in ROM: forward flexion, 145.2° vs 143.3°; external rotation with 90° of abduction, 88.1° vs 86.2°; external rotation at side, 88.9° vs 82.9°; and internal rotation, 9.1° vs 8.3°. Posterior extended capsular release might not be necessary in arthroscopic surgery for shoulder stiffness.

Repair of the rotator cuff tear is a joint-tightening procedure that can worsen joint stiffness. This paradoxical phenomenon complicates treatment of rotator cuff tear with joint stiffness. As a result, there is controversy about how and when to treat joint stiffness. As many treatments have been published, this review discusses the latest findings on treatment of rotator cuff tear with joint stiffness.