Risk Factors for Early Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

TL;DR

This study investigated risk factors for early shoulder stiffness after arthroscopic rotator cuff repair but found no significant associations with clinical or structural variables.

Contribution

The study contributes by systematically analyzing preoperative comorbidities and MRI-based tear features in relation to postoperative shoulder stiffness.

Findings

Early postoperative shoulder stiffness occurred in 6.3% of patients.

No significant associations were found between EPS and clinical comorbidities or anatomical tear features.

Standardized criteria are needed to identify high-risk patients for EPS.

Abstract

Introduction: Arthroscopic rotator cuff repair (ARCR) is the gold standard for treating symptomatic rotator cuff tears. Despite its benefits, early postoperative shoulder stiffness (EPS (shoulder)) remains a concern, with reported incidence varying widely. Identifying risk factors is crucial for optimizing outcomes. This study aimed to test whether preoperative clinical comorbidities and MRI-based structural tear features are associated with EPS after ARCR, where EPS was the primary outcome (present/absent) defined as persistent passive range of motion (ROM) limitation >90 days postoperatively.

Methods: This retrospective cohort study analyzed 381 patients who underwent primary ARCR at a tertiary referral center between December 2017 and February 2022. Data were collected retrospectively through electronic medical records and managed in a secure institutional database. Patients with preoperative stiffness or requiring additional procedures such as biceps tenodesis, capsular release, or distal clavicle resection were excluded. Clinical variables, including age, sex, diabetes, arterial systemic hypertension, dyslipidemia, and hypothyroidism, were assessed. Rotator cuff tears characteristics were analyzed through preoperative MRI and categorized using the Snyder, Cofield, Patte, and Goutallier (Fuchs modified) classifications.

Results: EPS was observed in 6.3% (24/381) of patients. The mean age of patients with EPS was 57.4 ± 11.1 years, compared to 59.9 ± 9.5 years in the non-stiffness group (p = 0.056). Women represented 75% of the EPS group versus 60.8% in the non-EPS group (p = 0.242). No significant associations were found between EPS and diabetes (p = 0.592), hypertension (p = 0.271), dyslipidemia (p = 0.220), or hypothyroidism (p = 0.999). Regarding anatomical characteristics, 87.5% of EPS cases involved full-thickness tears, compared to 80.1% in the non-EPS group (p = 0.592). Tear size, tendon retraction, and fatty degeneration showed no significant association with EPS.

Conclusion: No clinical or structural variables were significantly associated with EPS after ARCR. Standardized criteria are needed to identify high-risk patients and refine preventive strategies.

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