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Risk Factors of Postoperative Shoulder Stiffness After Rotator Cuff Repair: A Systematic Review and Meta-Analysis.

Songci Wang^1,2, Pu Zhang¹, Jianhao Xie¹

¹Department of Sports Medicine & Shoulder, Beijing Jishuitan Hospital, Beijing, China.

|October 24, 2025

Summary

Postoperative shoulder stiffness after rotator cuff repair is linked to advanced age, being female, diabetes, thyroid disease, and workers' compensation. These factors require clinical attention for better patient outcomes.

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Area of Science:

Orthopedics
Evidence-Based Medicine
Systematic Review & Meta-Analysis

Background:

Rotator cuff repair (RCT) is a common procedure for rotator cuff tears.
Postoperative shoulder stiffness (PSS) is a frequent complication impacting recovery and quality of life.
Existing research on PSS risk factors is inconsistent, necessitating a quantitative analysis.

Purpose of the Study:

To systematically review and meta-analyze risk factors for PSS following RCT.
To provide an evidence-based foundation for clinical practice regarding PSS prevention and management.

Main Methods:

Comprehensive literature search across PubMed, EMBASE, Cochrane, and Web of Science databases.
Inclusion of cohort and case-control studies, extracting risk factors and effect sizes.
Meta-analysis performed using Stata/SE 17.0 with fixed-effect or random-effect models based on heterogeneity, including subgroup and sensitivity analyses.

Main Results:

Eighteen studies with 63,565 patients analyzed 20 potential risk factors.
Significant risk factors for PSS include advanced age (MD 0.23, p=0.027), female sex (OR 1.99, p<0.001), diabetes (OR 2.01, p=0.015), thyroid disease (OR 1.32, p=0.004), and workers' compensation insurance (OR 1.92, p=0.022).
Subgroup analyses revealed female sex in non-Asian populations (OR 2.17, p<0.001) and preoperative shoulder stiffness (OR 1.64, p=0.035) as significant factors.

Conclusions:

Multiple factors contribute to PSS after RCT.
Advanced age, female sex, diabetes, thyroid disease, and workers' compensation are identified as high-risk factors.
Emphasizes comprehensive preoperative evaluation and individualized perioperative management, particularly for high-risk individuals.