Wang, JBJS Rev 2025 - Risk Factors of Postoperative Shoulder Stiffness after Rotator Cuff Repair: A Systematic Review and Meta-Analysis

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

Wang, Jiang, et al.·JBJS Rev·2025·3 citations

Background

Rotator cuff repair is a common and effective method for treating rotator cuff tears (RCTs). At the same time, postoperative shoulder stiffness (PSS) remains a common adverse complication that may seriously affect patients' postoperative recovery and quality of life. Existing studies have reported inconsistent results on risk factors of PSS, and a systematic quantitative analysis is required. This study aims to identify the risk factors for PSS after RCT through a systematic review and meta-analysis and provide an evidence-based basis for clinical practice.

Methods

We searched PubMed, EMBASE, Cochrane, and Web of Science databases from their establishment date to November 2024.
Cohort and case-control studies that met the criteria were included.
Relevant risk factors and their effect sizes were extracted.
Meta-analysis was performed using Stata/SE 17.0, and fixed-effect or random-effect models were selected and applied according to the level of heterogeneity.
Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed.

Results

18 studies involving 63,565 patients were included, and 20 potential risk factors were analyzed.
Among them, age (mean difference 0.23, 95% confidence interval [CI] 0.03-0.43, p = 0.027), female (odds ratio [OR] 1.99, 95% CI 1.69-2.32, p < 0.001), diabetes (OR 2.01, 95% CI 1.15-3.52, p = 0.015), thyroid disease (OR 1.32, 95% CI 1.09-1.59, p = 0.004), and workers' compensation insurance (OR 1.92, 95% CI 1.10-3.37, p = 0.022) were associated with PSS.
Subgroup analyses indicated that female in non-Asian populations (OR 2.17, 95% CI 1.66-2.84, p < 0.001) and preoperative shoulder stiffness in patients with a follow-up of more than 3 months (OR 1.64, 95% CI 1.03-2.60, p = 0.035) were significantly associated with PSS.

Conclusions

PSS after RCT is affected by multiple factors. According to current evidence, advanced age, female, diabetes, thyroid disease, and workers' compensation insurance are high-risk factors. Clinical attention should be paid to comprehensive preoperative evaluation and individualized management strategies, especially to strengthen intervention during the perioperative period in high-risk groups.

Level of evidence: Level V. Copyright remains with the authors and publisher.

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

Wang, Jiang, et al.·JBJS Rev·2025·3 citations

Background

Rotator cuff repair is a common and effective method for treating rotator cuff tears (RCTs). At the same time, postoperative shoulder stiffness (PSS) remains a common adverse complication that may seriously affect patients' postoperative recovery and quality of life. Existing studies have reported inconsistent results on risk factors of PSS, and a systematic quantitative analysis is required. This study aims to identify the risk factors for PSS after RCT through a systematic review and meta-analysis and provide an evidence-based basis for clinical practice.

Methods

We searched PubMed, EMBASE, Cochrane, and Web of Science databases from their establishment date to November 2024.
Cohort and case-control studies that met the criteria were included.
Relevant risk factors and their effect sizes were extracted.
Meta-analysis was performed using Stata/SE 17.0, and fixed-effect or random-effect models were selected and applied according to the level of heterogeneity.
Subgroup analysis, sensitivity analysis, and publication bias assessment were also performed.

Results

18 studies involving 63,565 patients were included, and 20 potential risk factors were analyzed.
Among them, age (mean difference 0.23, 95% confidence interval [CI] 0.03-0.43, p = 0.027), female (odds ratio [OR] 1.99, 95% CI 1.69-2.32, p < 0.001), diabetes (OR 2.01, 95% CI 1.15-3.52, p = 0.015), thyroid disease (OR 1.32, 95% CI 1.09-1.59, p = 0.004), and workers' compensation insurance (OR 1.92, 95% CI 1.10-3.37, p = 0.022) were associated with PSS.
Subgroup analyses indicated that female in non-Asian populations (OR 2.17, 95% CI 1.66-2.84, p < 0.001) and preoperative shoulder stiffness in patients with a follow-up of more than 3 months (OR 1.64, 95% CI 1.03-2.60, p = 0.035) were significantly associated with PSS.

Conclusions

PSS after RCT is affected by multiple factors. According to current evidence, advanced age, female, diabetes, thyroid disease, and workers' compensation insurance are high-risk factors. Clinical attention should be paid to comprehensive preoperative evaluation and individualized management strategies, especially to strengthen intervention during the perioperative period in high-risk groups.

Level of evidence: Level V. Copyright remains with the authors and publisher.

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