Rotator cuff injuries occur in more than 50% of people over 65 years old, and 40% of them develop into massive rotator cuff tears (MRCT) . Rotator cuff injuries can lead to persistent pain, dysfunction, and shoulder adhesion that can seriously affect the patient's quality of life. Rotator cuff injury combined with shoulder adhesion belongs to secondary shoulder adhesion. Currently, there are few studies on the treatment of rotator cuff injury combined with shoulder adhesion at home and abroad. Bhatia et al. argued that rotator cuff injury combined with shoulder adhesion should be treated in stages: first, shoulder adhesion should be treated, and then rotator cuff repair should be performed in the second stage. Favejee et al. suggested that functional training of the shoulder could alleviate shoulder adhesion to a certain extent, which would be beneficial to avoid re-adhesion of the shoulder after rotator cuff repair and would be of great significance for the rehabilitation of shoulder function. However, Xie Guoqing et al. believed that the conservative treatment of shoulder adhesion secondary to rotator cuff injury was mostly ineffective, and ultimately, both surgical release and rotator cuff repair were needed. Chen et al. also found that early rotator cuff repair and joint release achieved good efficacy for patients with rotator cuff injury combined with shoulder joint adhesion. Therefore, whether to perform shoulder joint release and rotator cuff repair at the same time or repair after release is still controversial. Objective To analyze and compare the clinical efficacy of primary and secondary surgery in patients of rotator cuff injury combined with shoulder adhesion.

From January 2019 to April 2020, 60 patients with rotator cuff injury combined with shoulder adhesion were selected from the clinical registration system for shoulder arthroscopy of our hospital. In the primary group, 30 patients underwent primary manual release, arthroscopic adhesiolysis, and rotator cuff repair, and in the secondary group, 30 patients underwent MUA (manipulation under anesthesia) manipulation first and then received arthroscopic adhesiolysis and rotator cuff repair. The shoulder range of motion was checked before the operation, in the 3rd, 6th, and 12th months after the operation, and at the last follow-up visit. MRI examinations of the affected shoulder were conducted at the 6th and 12th months postoperatively. The VAS (visual analogue scale) score, Constant score, and UCLA (University of California, Los Angeles) shoulder scoring system were pushed to patients through the shoulder arthroscopic clinical registration system.

The average follow-up time was 17 months in the primary group and 16 months in the secondary group. The shoulder ranges of motion in all directions during the postoperative follow-ups were significantly improved compared with those before the operation in the two groups (P<0.01) . The VAS scores, Constant scores, and UCLA shoulder scores in the two groups during the postoperative follow-ups were significantly improved compared with those before the operation (P<0.01) . In the primary group, 1 case of rotator cuff retears occurred 6 months after the operation. The ranges of shoulder anteflexion and abduction were better than those in the primary group (P<0.01) , but there was no significant difference in the range of motions in all directions between the two groups 3 months after the operation. The shoulder scores of the primary group were better than those of the secondary group at the 3rd and 6th months postoperatively (P<0.01) .

Rotator cuff retears in the primary group may be related to early exercises. In the secondary group, there existed an increased risk of pains, incomplete adhesiolysis, and aggravate injury due to manual adhesiolysis before surgery. In the primary group, the recovery of shoulder joint mobility was slow but the shoulder joint score and satisfaction were high compared with the secondary group at 3 and 6 months postoperatively. Both groups were satisfied with the shoulder score at 12 months postoperatively and the long-term clinical efficacy.