Prediction of Shoulder Stiffness After Arthroscopic Rotator Cuff Repair

Abstract

Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.

Effects of glenohumeral corticosteroid injection on stiffness following arthroscopic rotator cuff repair: a prospective, multicentric, case-control study with 18-month follow-up

“…The incidence of postoperative stiffness in patients undergoing ARCR surgery in our study was 49.8% (273/548 patients), which was higher than the 39% reported in the literature [ 1 - 3 , 15 ]. A possible explanation for the higher incidence of post-ARCR shoulder stiffness in the current study could be the higher percentage of female patients, lower mean patient age (<56 years) with lesser opportunity to experience tendon degeneration, and lack of acromioplasty in most patients undergoing ARCR, all of which have been reported as risk factors for post-ARCR stiffness [ 15 ].…”

Treatment of partial rotator cuff lesions is associated with a higher frequency of post-operative shoulder stiffness. A prospective investigation on the role of surgery-related risk factors for this complication

“…Similarly, Peters et al measured an inferior ROM in abduction and external rotation and documented greater difficulty with reaching behind the back and with overhead activities six months after TCR of partial-thickness tears as compared to repair of full-thickness ones, however without obtaining a statistical significance in their results [14]. A recent clinical registry study by Audigé et al also documented a similar rate of post-operative SS and identified partial tears treatment as a risk factor for developing post-operative SS [25].…”

“…Numerous other risk factors have been described in relation to the occurrence of SS, including pre-, intra-and postoperative factors. In the last years, particular interest has been dedicated to the pre-operative risk factors, adding to the well-known ones such as diabetes mellitus and thyroid disease newer ones, like disorders of lipid metabolism and overweight, vitamin D deficiency, gastroesophageal diseases, genetic polymorphisms (e.g., IL-6 and MMP-3) and increased inflammatory changes in the shoulder joint [2,9,24,25,37,[45][46][47][48]. Considered the growing number of possible pre-operative risk factors for SS and the need of specific investigations to assess the presence of many of them, the authors decided to document and include in this study on the role of surgery-related risk factors only age, gender and body mass index, considering the first two also in the multivariate analysis.…”

Approaching Artificial Intelligence in Orthopaedics: Predictive Analytics and Machine Learning to Prognosticate Arthroscopic Rotator Cuff Surgical Outcomes

“…Our results did not demonstrate a strong association between gender and post-operative ASES scores, another area of conflicting findings in the literature. Several studies show female sex to be associated with worse post-operative quality of life, mental health, pain, and functional assessments [ 26 , 27 , 48 , 49 , 50 , 51 ]. Conversely, other studies demonstrate that gender does not influence post-operative outcomes [ 39 ].…”