Abstract
The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). Two hundred seventy-four patients who underwent primary ARCR were included. At 3 months after surgery, criteria for shoulder stiffness was set as follows: (1) passive forward flexion < 120˚, or (2) external rotation at side < 30˚. Patients with preoperative stiffness or who underwent additional procedures were excluded. Patients-related, radiological (muscle atrophy and fatty infiltration), and intraoperative (tear size, repair techniques, number of anchors used, and synovitis scores) risk factors were analyzed. Univariate and multivariate analyses were used to identify risk factors for postoperative stiffness. Thirty-nine of 274 patients (14.2%) who underwent ARCR developed postoperative stiffness. Univariate analyses revealed that early postoperative stiffness was significantly associated with diabetes mellitus (p = 0.030). However, radiological and intraoperative factors did not affect postoperative shoulder stiffness (all p > 0.05). Multivariate analyses revealed early postoperative stiffness was significantly associated with diabetes mellitus and timing of rehabilitation (p = 0.024, p = 0.033, respectively). The overall incidence of early postoperative stiffness following isolated ARCR in patients without preoperative stiffness was 14.2%. Diabetes mellitus and timing of rehabilitation were independent risk factors for early postoperative stiffness following ARCR.
Highlights
The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR)
Of the 274 patients treated with primary ARCR, 39 patients (14.2%) developed shoulder stiffness at 3 months after surgery
There were no significant differences in age, sex, body mass index (BMI), thyroid disease, hyperlipidemia, duration of symptom, dominant arm, trauma, the intensity of labor, or level of sports activity between the two groups, the prevalence of diabetes mellitus (DM) was significantly different between the two groups (p = 0.030)
Summary
The purpose of this study was to investigate the incidence and risk factors of early postoperative stiffness in patients without preoperative stiffness undergoing isolated arthroscopic rotator cuff repair (ARCR). The ability to better assess the risk and prevent postoperative stiffness is crucial, in the early postoperative period Various risk factors, such as preoperative shoulder stiffness, female, diabetes mellitus (DM), hypothyroidism, operative technique, additional procedures, prolonged immobilization, and glenohumeral joint (GHJ) synovitis, have been suggested as causes of postoperative stiffness after ARCR8 ,14–16. Despite awareness of these risk factors, few studies have comprehensively analyzed patient-related, radiological, and intraoperative risk factors for early postoperative stiffness after ARCR. We hypothesized that the incidence of early postoperative stiffness would be higher than the previously reported values, and specific risk factors might be related to early postoperative stiffness
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