Stiffness and arthroscopic rotator cuff repair: a literature review

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.