There are many theories regarding the pathogenesis of rotator cuff injury, with the most common being external impingement, internal impingement, and tendons intrinsic degeneration. External impingement includes subacromial impingement and subcoracoid impingement, while internal impingement involves entrapment of the posterosuperior rotator cuff tendons between the humeral head and posterior glenoid during abduction and external rotation. The cause of tendons intrinsic degeneration is generally consider to be the consequence of overuse [
6]. Arthroscopic rotator cuff suture and simultaneous 360° capsular release have a significant effect on the treatment of rotator cuff tear with limited shoulder movement [
7]. The initial pain that accompanies a rotator cuff tendinopathy is not obvious in the case of a mild injury, while severe pain occurs immediately in severe cases. The clinical manifestations are night pain, back and hand pain, and “pain arc”. Shoulder joint movement is limited, and the free abduction and forward flexion cannot be performed, and serious obstacles to life [
8]. Due to a lack of accurate diagnostic methods in the early stage, misdiagnosis frequently occurs and the optimal treatment time is delayed. In 1931, Codman [
9] was the first to systematically describe the manifestations of rotator cuff injuries and proposed diagnostic and surgical methods for each manifestation. Early treatment of rotator cuff injuries is mostly conservative, with surgery following recovery of passive motion or failure of conservative treatment [
10]. Research has confirmed that conservative treatment can alleviate symptoms of rotator cuff tear, but cannot improve range of motion in the long term [
1]. The basis for this finding is that manual release has little effect on improving the range of motion of the glenohumeral joint, unlike the relative range of motion between the scapula and chest wall. Conservative treatment has limitations. In fact, although the potential complications of surgical treatment (such as postoperative stiffness, infection) cannot be ignored, conservative treatment cannot restore the tendon, which increases the risk of shoulder tendon degeneration over time [
11]. Depending on patient needs, MRCT surgical treatment may have different goals and there are different arthroscopic approaches to address the problem. Debridement and long head of the biceps tenotomy or tenodesis have been used in patients with less demanding conditions where the main symptom is pain and shoulder function is sufficient for their activities of daily living [
12]. Tuberoplasty [
13] and “insertion techniques” such as subacromial balloon [
14] and superior capsule reconstruction (SRC) [
15] are designed to relieve pain and improve function by facilitating subacromial slide of the humeral head, lower the humerus head. Arthroscopic repair or partial repair can improve function and control pain.
With the rapid development of medical technology, the update of imaging instruments (color Doppler, CT, and MRI) has improved the diagnostic accuracy of rotator cuff injuries, and the emergence of arthroscopy has compensated for the shortcomings of traditional diagnosis and treatment methods.Arthroscopic rotator cuff repair surgery is an effective means to solve the above problems. Arthroscopic rotator cuff suture, as a surgical method to repair the torn rotator cuff, achieves mechanical balance, repairs acromion impingement, and plays an important role in the treatment of rotator cuff injuries. Since the 1990s, many surgeons have proposed arthroscopic minimally invasive techniques. This method has become a common choice for patients with rotator cuff injuries after conservative treatment fails. Early arthroscopy was only used for simple debridement of lesions, and major intra-articular surgeries can now be performed using an arthroscope [
16].
There are three ranges of arthroscopic release: 90°; 270°; and 360°. Arthroscopic lateral supine 360 degree joint capsule release surgery for the treatment of idiopathic joint capsule adhesion can significantly improve the range of motion in an early and persistent manner, achieve good functional results, and reduce revision and complication rates [
17]. The importance of improving shoulder function is explained in detail. This surgical method can be performed only under arthroscopy, without the need to separate the deltoid muscle or make a large incision on the body. Brenneke et al. found that the shoulder capsular tissues in different positions help to stabilize the shoulder in different orientation [
18], which may contribute to the stiffness of the shoulder. Ma and other studies also have shown that patients with rotator cuff injuries can greatly improve symptoms after rotator cuff suturing and arthroscopic 360° capsular release treatment [
7]. Our study also showed that after rotator cuff suturing and arthroscopic 360° capsular release in patients with a rotator cuff tear, the Constant-Murley score was significantly increased, the VAS score was significantly decreased, the shoulder flexion angle was significantly increased, and postoperative clinical healing achieved a high rate. However, capsular release can cause postoperative micro-instability, and the lack of evaluation of long-term functional and radiological outcomes is a limitation.
This finding shows that rotator cuff suturing and arthroscopic 360° capsular release have a significant effect on the treatment of patients with a rotator cuff tear with limited shoulder movement.