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Risk Factors of Postoperative Shoulder Stiffness After Rotator Cuff Repair: A Systematic Review and Meta-Analysis #MMPMID41134926
Wang S; Zhang P; Xie J; Jiang C
JBJS Rev 2025[Oct]; 13 (10): ? PMID41134926show ga
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: Eighteen 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. CONCLUSION: 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. See Instructions for Authors for a complete description of levels of evidence.
JBJS+Rev 2025 ; 13 (10): ?
