What is the optimal surgical intervention for patients with frozen shoulder and a concomitant partial-thickness rotator cuff tear?

BACKGROUND: Patients with recalcitrant frozen shoulder traditionally undergo arthroscopic capsular release. Some patients may have a concomitant partial-thickness rotator cuff tear (PTT). There is limited evidence if these PTT require repair at the same setting. We aim to compare if patients undergoing concomitant rotator cuff repair do better than patients undergoing capsular release alone. Secondarily, we aim to determine if outcomes after arthroscopic capsular release differ for patients with and without PTT. METHODS: A retrospective review of patients with frozen shoulders undergoing arthroscopic capsular release between 2012 and 2016 was performed. Patients with partial-thickness tears and patients without rotator cuff tears were included. Clinical outcomes were collected preoperatively and at 3, 6, 12 months after operation. RESULTS: There were 33 patients with PTT—15 underwent capsular release without repair (CR group), whereas 18 underwent capsular release with rotator cuff repair (RCR group). A total of 62 control patients without rotator cuff tears (No Tear) underwent arthroscopic capsular release only. For patients with PTT, there were no significant differences in preoperative demographics and function between the CR and RCR group. The CR group had significantly worse preoperative pain. At 1-year follow-up, the RCR group had significantly better internal rotation, lesser pain, and better function than the CR group. For patients undergoing capsular release only, the No Tear group had better internal rotation, lesser pain, and better function at 1 year compared with the CR group. CONCLUSION: Patients with a stiff, frozen shoulder and concomitant PTT do benefit from arthroscopic rotator cuff repair with capsular release. The benefit is evident at 1-year follow-up.