Stiffness after arthroscopic rotator cuff repair: a rehabilitation problem or a surgical indication?

The purpose of this study was to determine the incidence of clinically significant postoperative stiffness after arthroscopic rotator cuff repair and its resolution. The study also sought to determine clinical and surgical factors that may be associated with increased rates of postoperative stiffness.

We conducted a level III retrospective review of a consecutive series of arthroscopic rotator cuff repairs. During a 5-year period, the senior author (C.J.R.) performed 150 arthroscopic rotator cuff repairs at our institution. Demographic data, comorbid medical conditions, descriptions of rotator cuff tears (including size and level of retraction), and concomitant surgical procedures were evaluated on their correlation with stiffness. All office visits were reviewed to determine preoperative and postoperative motion. Patients were followed up at 1 week, 3 weeks, 6-8 weeks, 3 months, about 6 months, and 1 year postoperatively.

In our analysis of tear types, we were unable to associate stiffness with the type of tear, the tendon torn, or the number of tendons torn or with whether the tendons were retracted. However, we were able to associate female sex, workers' compensation insurance, and a concomitant biceps procedure with stiffness at several time points. The incidence of stiffness was highest at 12 weeks, with 7.3% of patients presenting with stiffness. The rate of stiffness decreased with continued follow-up. Stiffness was found in 3.3% of patients at 16-24 weeks and in 1.6% of patients at 1 year.

Prolonged physical therapy will result in resolution of stiffness in the vast majority of cases, often obviating the return to the operating room for capsular release and lysis of adhesions or mobilization under anesthesia.