Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2022; 10(15): 5097-5102
Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.5097
Knot impingement after arthroscopic rotator cuff repair mimicking infection: A case report
Du-Han Kim, Jong-Hyuk Jeon, Byung-Chan Choi, Chul-Hyun Cho
Du-Han Kim, Jong-Hyuk Jeon, Byung-Chan Choi, Chul-Hyun Cho, Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
Author contributions: Cho CH and Kim DH performed the conceptualization; Choi BC contributed to the investigation; Choi BC and Kim DH contributed to the data curation; Jeon JH wrote the original draft preparation; Cho CH wrote the review and editing, performed the supervision; Kim DH wrote the project administration; all authors have read and agreed to the published version of the manuscript.
Supported by National Research Foundation of Korea, No. 2021R1F1A1047546.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chul-Hyun Cho, PhD, Professor, Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, No. 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, South Korea. oscho5362@dsmc.or.kr
Received: March 22, 2021
Peer-review started: December 22, 2021
First decision: February 21, 2022
Revised: February 22, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 26, 2022
Abstract
BACKGROUND

Knot impingement as a complication after arthroscopic rotator cuff repair (ARCR) has been suggested as a cause of persistent pain with limited motion. We report on a case involving a patient who developed knot impingement after ARCR who complained of acute onset of pain with limited motion, which was confused with infection.

CASE SUMMARY

A 55-year-old female who complained of severe pain with limited motion of the right shoulder visited our emergency room. Passive range of motion could not be evaluated due to the patient’s severe pain. The patient had undergone ARCR using a suture-bridge technique at a local clinic four months ago for treatment of a small supraspinatus tear of the right shoulder. An erosive change of the undersurface of the acromion was observed on plain radiographs of the right shoulder, and a moderate amount of bursal fluid and synovial thickening with enhancement was observed by magnetic resonance imaging. Results of an analysis of the aspirated fluid showed that the WBC count was 3960 with 90% neutrophils. The arthroscopic view showed healing of the repaired supraspinatus tendon and loose suture threads and knots with severe subacromial bursitis were observed. Debridement of inflammatory tissues of the glenohumeral joint and subacromial space was performed for the removal of all suture materials. The patient’s symptoms subsided immediately after the surgical procedure.

CONCLUSION

Although the incidence of knot impingement is rare, the possibility of knot impingement after ARCR should be a consideration.

Keywords: Rotator cuff, Knot impingement, Shoulder, Infection, Arthroscopy, Case report

Core Tip: Arthroscopic rotator cuff repair (ARCR) is a procedure that is widely performed with satisfactory outcomes. Development of knot impingement as a rare complication after ARCR has been suggested as a cause of persistent pain with limited motion. Because of its rarity, knowledge regarding clinical features in patients with knot impingement after ARCR is limited. We suggest consideration of knot impingement after ARCR as a cause of acute shoulder pain.