The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review

Abstract

Rotator cuff tear (RCT) is a common shoulder condition frequently treated with arthroscopic rotator cuff repair (ARCR) after conservative interventions have failed. Postoperative shoulder stiffness (POSS) is a common complication after ARCR. The purpose of this study is to determine the incidence of POSS after ARCR in total and based on tear extent prior to ARCR. A systematic review was performed using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and ScienceDirect databases. The search terms were "rotator cuff repair" AND "arthrofibrosis" OR "postoperative shoulder stiffness." Articles were selected based on ARCR and the presence of POSS documentation. Twenty-five articles out of 284 articles met the final selection criteria after reviewing for patients who received ARCR. Out of all patients (n=9,373), 597 had POSS (6.4%). Out of the 2,424 patients with a specified tear pattern, 96 out of 1,862 (5.2%) patients with full-thickness tears and 58 out of 562 (10.3%) patients with partial-thickness tears had POSS after ARCR. Partial-thickness tears are associated with higher rates of POSS after ARCR as compared to full-thickness tears (p<0.001). Overall, POSS is a common complication after ARCR with an incidence of 6.4%, regardless of tear type. POSS is more common in patients who receive ARCR for partial-thickness RCT (10.3%) as compared to patients who receive ARCR for full-thickness RCT (5.2%). More research is needed to determine other factors impacting the incidence of POSS after ARCR.

Factors Affecting Postoperative Rehabilitation Therapy Utilization After Arthroscopic Rotator Cuff Repair: An Epidemiological Analysis

“…No other studies in the literature have examined the impact of the RCT extent on postoperative PT usage after ARCR, and hence the finding that PT utilization is higher in partial versus complete RCTs is a novel finding with clinical implications. POSS, another common complication after ARCR, has also been shown to have a higher incidence in female patients and those with partial tears, which aligns with the findings of our study [ 9 , 11 ]. The correlation between increased incidence of POSS after ARCR and increased postoperative PT needs to be further explored.…”

“…This warrants further research to examine how early vs. later postoperative PT usage can impact complications such as POSS. Strengths of our study include the large sample size (n = 21,540) and the differentiation between ARCR for partial and complete RCT, as compared to previous studies [ 11 , 14 , 18 ]. Another strength of our study is the use of the TriNetX database, which is sourced directly from HCOs as opposed to third-party vendors, like some other database studies [ 23 ].…”

“…A common postoperative complication after ARCR is postoperative shoulder stiffness (POSS), which can result in increased healthcare costs and unfavorable patient outcomes [ 6 - 9 ]. The incidence of POSS is highly variable and ranges from 2% to 28% in the literature [ 4 , 10 , 11 ]. Furthermore, POSS has been shown to be more frequent based on various covariates, such as female sex and the extent of RCT, which may have an impact on postoperative physical therapy (PT) utilization after ARCR [ 9 , 11 ].…”

“…The incidence of POSS is highly variable and ranges from 2% to 28% in the literature [ 4 , 10 , 11 ]. Furthermore, POSS has been shown to be more frequent based on various covariates, such as female sex and the extent of RCT, which may have an impact on postoperative physical therapy (PT) utilization after ARCR [ 9 , 11 ]. Postoperative PT is common after ARCR and is widely considered a critical component for patient recovery and improved outcomes [ 12 - 15 ].…”

“…Postoperative PT is common after ARCR and is widely considered a critical component for patient recovery and improved outcomes [ 12 - 15 ]. Furthermore, PT has been used to manage complications, such as POSS, after ARCR [ 1 , 11 , 14 , 16 ]. It is possible that the utilization of PT after ARCR could impact postoperative complications and patient outcomes.…”