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Review
. 2023 Jan 9:8:7.
doi: 10.21037/aoj-22-26. eCollection 2023.

Stiffness and arthroscopic rotator cuff repair: a literature review

Allen A Guo  1 , Lisa Hackett  1 , George A C Murrell  1
Affiliations
Review

Stiffness and arthroscopic rotator cuff repair: a literature review

Allen A Guo et al. Ann Jt. .

Abstract

Background and objective: Tendon retear is the most common complication following rotator cuff repair surgery. Understanding the factors that are associated with greater risks of retear is important so surgeons can provide accurate prognostic information to patients. Advanced age and larger tear size have been shown to be associated with greater risk of retear at 6 months using multiple logistic regression analysis. Stiffness is the second most common complication, however recent evidence suggests that early postoperative stiffness may be associated with a more robust healing response. Thus, this paper aims to critically review the independent predictors of retear in rotator cuff repair patients.

Methods: Literature review was conducted using electronic databases from their dates of inception.

Key content and findings: There are multiple factors that affect rotator cuff repair integrity detailed in the literature. Tear size appeared to be the most important predictor of retear following rotator cuff repair. Postoperative stiffness at 6 and 12 weeks after surgery appears to be a factor associated with more intact repairs at 6 months. Shoulder stiffness tends to resolve within 6 months following the operation. This protective effect persists up to 5 years postoperatively.

Conclusions: Shoulder stiffness may be an important protective factor against rotator cuff retear which requires further investigation from future studies. It is important to determine the relative importance of stiffness when compared to known important factors such as tear size with regards to its effect on rotator cuff repair integrity.

Keywords: Stiffness; arthroscopic rotator cuff repair; retear; tear size.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-26/coif). GACM is on the editorial board of both Journal of Shoulder and Elbow Surgery, and Shoulder & Elbow (UK) and is a paid consultant for Smith and Nephew. Siemens and General Electric provide ultrasound equipment to be used to collect data in the study. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Retear rates according to varying anteroposterior tear size, patient ages, case numbers and hospital types. (A) Case number 1,000 in a private hospital; (B) case number 1,000 in a public hospital; (C) case number 3,000 in a private hospital; (D) case number 3,000 in a public hospital. Retear rates increased 4-fold when anteroposterior tear length increased from 1 to 3 cm, when other factors were controlled. Figure reproduced from (19).
Figure 2
Figure 2
Comparison of retear rates between stiff and non-stiff groups. Lower retear rates seen in group with preoperative stiffness compared to group without at 6 months and 2 years follow-up. Figure reproduced from (60). RCR, rotator cuff repair; MUA, manipulation under anaesthesia; CR, capsular release.
Figure 3
Figure 3
Ultrasound changes after rotator cuff repair. A (A) pictorial representation and (B) graphical representation of changes in bursal thickness, capsule thickness, tendon vascularity and shoulder stiffness over 6 months after operation. ***, P<0.001. Figure reproduced from (64).
Figure 4
Figure 4
Long term rotator cuff repair integrity. Intact rotator cuff repair survival in patients with postoperative stiff vs. non-stiff shoulders over 9 years follow-up. Figure reproduced from (59).
See this image and copyright information in PMC

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