Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair

Mercedes Salas; Brandon Zaldivar; Guido Fierro; Juan Carlos Gonzalez; Jorge Rojas Lievano

doi:10.1007/s00402-024-05323-4

Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair

Arch Orthop Trauma Surg. 2024 Apr 17. doi: 10.1007/s00402-024-05323-4. Online ahead of print.

Authors

Mercedes Salas¹, Brandon Zaldivar², Guido Fierro^{3

4}, Juan Carlos Gonzalez^{3

4}, Jorge Rojas Lievano^{5

6}

Affiliations

¹ Universidad del Rosario, School of Medicine and Health Sciences, Department of Orthopedics and Traumatology, Calle 12C #6-25, Bogotá D.C, Colombia.
² Universidad de la Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, Chía, Colombia.
³ Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá, Calle 119 No. 7- 75, Bogotá D.C, Colombia.
⁴ Universidad de los Andes, School of Medicine, Carrera 1 #18A-12, Bogotá, Colombia.
⁵ Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá, Calle 119 No. 7- 75, Bogotá D.C, Colombia. jlrojasl25@gmail.com.
⁶ Universidad de los Andes, School of Medicine, Carrera 1 #18A-12, Bogotá, Colombia. jlrojasl25@gmail.com.

PMID: 38630250
DOI: 10.1007/s00402-024-05323-4

Abstract

Introduction: The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively.

Methods: In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark.

Results: Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2-15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups.

Conclusion: The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

Keywords: Arthroscopic surgery; Mini-open Repair; Postoperative outcomes; Rotator Cuff Repair; Shoulder stiffness.