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The Relationship Between Shoulder Stiffness and Rotator Cuff Healing: A Study of 1,533 Consecutive Arthroscopic Rotator Cuff Repairs

McNamara, William J.; Lam, Patrick H. PhD; Murrell, George A.C. MD, DPhil

Journal of Bone & Joint Surgery - American Volume: 16 November 2016 - Volume 98 - Issue 22 - p 1879–1889
doi: 10.2106/JBJS.15.00923
Scientific Articles

Background: Retear and stiffness are not uncommon outcomes of rotator cuff repair. The purpose of this study was to evaluate the relationship between rotator cuff repair healing and shoulder stiffness.

Methods: A total of 1,533 consecutive shoulders had an arthroscopic rotator cuff repair by a single surgeon. Patients assessed their shoulder stiffness using a Likert scale preoperatively and at 1, 6, 12, and 24 weeks (6 months) postoperatively, and examiners evaluated passive range of motion preoperatively and at 6, 12, and 24 weeks postoperatively. Repair integrity was determined by ultrasound evaluation at 6 months.

Results: After rotator cuff repair, there was an overall significant loss of patient-ranked and examiner-assessed shoulder motion at 6 weeks compared with preoperative measurements (p < 0.0001), a partial recovery at 12 weeks, and a full recovery at 24 weeks. Shoulders that were stiff before surgery were more likely to be stiff at 6, 12, and, to a lesser extent, 24 weeks after surgery (r = 0.10 to 0.31; p < 0.0001). A stiffer shoulder at 6 and 12 weeks (but not 24 weeks) postoperatively correlated with better rotator cuff integrity at 6 months postoperatively (r = 0.11 to 0.18; p < 0.001). The retear rate of patients with ≤20° of external rotation at 6 weeks postoperatively was 7%, while the retear rate of patients with >20° of external rotation at 6 weeks was 15% (p < 0.001).

Conclusions: In patients who developed stiffness after surgery, a rotator cuff repair was more likely to heal.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Orthopaedic Research Institute, St. George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia

E-mail address for G.A.C. Murrell: murrell.g@ori.org.au

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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