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Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively.

Methods

In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark.

Results

Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2–15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups.

Conclusion

The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

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Funding

No funding was received to assist with the preparation of this manuscript. The authors did not receive support from any organization for the submitted work and they all certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Author notes

  1. Juan Carlos Gonzalez

    Present address: Universidad de los Andes, School of Medicine, Carrera 1 #18A-12, Bogotá, Colombia

Authors and Affiliations

  1. Universidad del Rosario, School of Medicine and Health Sciences, Department of Orthopedics and Traumatology, Calle 12C #6-25, Bogotá D.C, Colombia

    Mercedes Salas

  2. Universidad de la Sabana, Campus del Puente del Común, Km. 7, Autopista Norte de Bogotá. Chía, Cundinamarca, Chía, Colombia

    Brandon Zaldivar

  3. Division of Shoulder and Elbow Surgery, Department of Orthopedics and Traumatology, Fundación Santa Fe de Bogotá, Calle 119 No. 7- 75, Bogotá D.C, Colombia

    Guido Fierro, Juan Carlos Gonzalez & Jorge Rojas Lievano

  4. Universidad de los Andes, School of Medicine, Carrera 1 #18A-12, Bogotá, Colombia

    Guido Fierro & Jorge Rojas Lievano

Authors
  1. Mercedes Salas
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Corresponding author

Correspondence to Jorge Rojas Lievano.

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This study was approved by our Institutional Review Board.

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Supplementary Material 1

Appendix

Appendix

Postoperative rehabilitation was performed by different physicians. However, the rehabilitation protocol is standardized and divided into 5 phases. In order to proceed to the following phase, the patient must accomplish the objectives of the previous stage with minimal pain.

Phase 1- immobilization phase (Week 0–4)

Patients were immobilized for 1 month, restricting shoulder movement, and instructed to perform exercises for the cervical spine, protraction and retraction of the scapula, and flexion and extension of the elbow, wrist, and fingers.

Phase 2- Passive Range of Motion Phase (Week 4–6)

Patients were referred to physiotherapist sessions to initiate pendulum exercises with gentle circular movements of no more than 20 centimeters in diameter (to avoid significant isometric contraction of the supraspinatus) and passive movements of the operated shoulder with the patient in the supine position (maximum flexion of 120 ° and external rotation of 30 °).

Phase 3- active Movement Phase (Week 6–12)

: Beginning at week 6, patient began active assisted exercises such as: scapula protraction and retraction both seated and in the supine position, flexion in the scapular plane and external rotation in the supine position, and progressive internal rotation exercises (without weight) in the lateral decubitus position. Moreover, extension and adduction of the shoulder plus isometric exercises of glenohumeral stabilizers were performed. From week 8 to 12, all active movements of the shoulder in supine and lateral decubitus position were performed. Scapular stabilizer strengthening exercises and proprioceptive neuromuscular exercises were progressively introduced. Starting at week 10, active exercises assisted with a weight bar, starting with one pound, was initiated.

Phase 4 - strength phase (Week 12 - Month 5)

After three months, the following exercises were started: rotator cuff and deltoid strengthening exercises with bands and weights, proprioceptive reeducation exercises, and plyometric exercises.

Phase 5 - advance strength phase

The advanced strengthening phase is focused on patients whose work or recreational demands require loads or positions not reached in phases 3 and 4. It consisted of continuing the exercises in phase four while progressively increasing resistance.

Return to work

Patients returned to work around 6 to 8 weeks postoperative depending on the type of work activity and surgeon discretion.

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Salas, M., Zaldivar, B., Fierro, G. et al. Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05323-4

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