Malpractice claims after arthroscopic rotator cuff surgery in France: a 10-year analysis of 73 expert-reviewed cases

Arthroscopic rotator cuff surgery has become one of the most frequently performed shoulder procedures in France. However, medico-legal claims following arthroscopic shoulder surgery remain poorly described in the French setting. The present study addressed the following questions: (1) What are the main reasons for claims after arthroscopic rotator cuff surgery? (2) What proportion of cases result in compensation and/or surgeon liability being upheld? (3) Are claim characteristics associated with a higher probability of surgeon liability being retained? (4) Which patient-, surgeon-, or procedure-related factors are associated with liability being retained?

We hypothesized that postoperative pain would represent the leading cause of claims, that surgeon liability would be retained in a minority of cases, and that the type of medico-legal procedure would be the characteristic most strongly associated with retained liability.

This retrospective observational study analyzed malpractice claims extracted from a national insurance database between 2014 and March 2024. Inclusion criteria were claims following arthroscopic procedures related to rotator cuff pathology (CCAM codes: MJEC001/002, MJDC001, MEMC003/005, etc.). Claims related to instability surgery and incomplete expert reviews were excluded. Patient, surgeon, surgery, and claim-related variables were collected. The primary outcome was surgeon liability retained (none vs. partial/full). Secondary outcomes included claim reasons, compensation outcome, and procedure type (CRCI, summary proceedings, amicable settlement). Statistical comparisons used the Fisher exact test or Chi² for categorical variables and the Kruskal-Wallis for continuous variables. Risk ratios (RR) were calculated with 95% confidence intervals.

Most claims were initiated through CRCI procedures (41 cases, 56%). Claimants were predominantly professionally active (65 cases, 89%), most often manual workers (49 cases, 67%), non-smokers (60 cases, 82%), and in good general health (ASA 1-2 in 96%). Body mass index was distributed across normal weight (43%), overweight (30%), and obesity (25%) categories. Pain was the leading reason for complaint (49 cases, 67%), and was frequently associated with CRPS (approximately half of pain-related claims). Infection accounted for 12% of claims and neurological complications for 7%, including cases related to locoregional anesthesia. Surgeon liability was not retained in 59 cases (81%), partially retained in 9 (12%), and fully retained in 5 (7%). Compensation was awarded in 7 cases (10%), with a mean amount of €17,940 ± 12,368. Liability was significantly associated with the type of procedure (χ² = 11.62; p = 0.003), being more frequent in amicable settlements (62.5%) compared with CRCI (17.1%) or summary proceedings (8.3%).

After arthroscopic rotator cuff surgery, pain-particularly when associated with CRPS-represents the primary source of malpractice claims. However, surgeon liability is retained in fewer than a seventh of cases. Procedural context appears to influence the probability of retained liability. Thorough documentation and clear patient information remain essential to medico-legal protection and improved patient care.

IV; retrospective observational study.