Recovery Trajectory of Range of Motion and Its Association With Patient Factors During Early Postoperative Stiffness...

Postoperative shoulder stiffness may influence functional recovery after arthroscopic rotator cuff repair. However, predictors for progression to persistent shoulder stiffness have not been clearly established.

To identify factors associated with persistent stiffness and describe range of motion (ROM) recovery trajectory after arthroscopic repair of full-thickness rotator cuff tears.

Cohort study; Level of evidence, 3.

We retrospectively reviewed 352 patients who underwent arthroscopic complete repair. Stiffness was defined as forward flexion <120°, external rotation <30°, or internal rotation below L3. ROM, visual analog scale (VAS) score, American Shoulder and Elbow Surgeons score, Constant score, and tendon integrity were assessed, and patients reported the primary barrier to rehabilitation at 3 months. Predictors of persistent stiffness at 6 months were evaluated using multivariate logistic regression.

At 3 months, 165 patients (46.9%) met stiffness criteria. Compared with patients without stiffness, the stiffness group had poorer functional outcome (P < .001), higher pain (VAS, 2.2 ± 1.1 vs 1.8 ± 1.2; P = .002), and a lower retear rate (6.7% vs 14.4%; P = .019). Among patients with early stiffness, 34 (20.6%) had persistent stiffness at 6 months. Fear or anxiety about tendon retear was the most common barrier (50.3%), followed by pain (32.7%); however, persistent stiffness was most prevalent when pain was the primary barrier (67.6%). Higher pain score at 3 months independently predicted persistent stiffness (odds ratio, 1.44 [95% CI, 1.01-2.05]; P = .044).

Early stiffness after arthroscopic rotator cuff repair is heterogeneous. Pain-driven stiffness is associated with persistence, whereas stiffness related to fear or anxiety about tendon retear is common but largely reversible; tailored management may improve recovery.