The purpose of this study was to determine the incidence of clinically significant
postoperative stiffness following arthroscopic rotator cuff repair. This study also
sought to determine the clinical and surgical factors that were associated with higher
rates of postoperative stiffness. Finally, we analyzed the result of arthroscopic
lysis of adhesions and capsular release for treatment of patients who developed refractory
postoperative stiffness 4 to 19 months (median, 8 months) following arthroscopic rotator
cuff repair.
A retrospective review of a consecutive series of arthroscopic rotator cuff repairs
was conducted. During a 3-year time period, the senior author (S.S.B.) performed 489
arthroscopic rotator cuff repairs. The operative indications, technique of the rotator
cuff repair, and the rehabilitation protocol were essentially unchanged during this
time period. Demographic data, comorbid medical conditions, rotator cuff tear description,
technique of repair, and concomitant surgical procedures were evaluated for their
effect on stiffness. All office evaluations were reviewed to determine the pre- and
postoperative motion, pain scores, functional strength, and patient satisfaction.
Patients who were dissatisfied because of the development of postoperative stiffness
underwent secondary arthroscopic lysis of adhesions. The final result of the secondary
lysis of adhesions and capsular release were analyzed.
In total, 24 patients (4.9%) were dissatisfied with the result of their procedure
because of the development of postoperative stiffness, which was more likely (P <
.05) to develop in patients with Workers' Compensation insurance (8.6%), patients
younger than 50 years of age (8.6%), those with a coexisting diagnosis of calcific
tendonitis (16.7%) or adhesive capsulitis (15.0%) requiring additional postoperative
therapy, partial articular-sided tendon avulsion (PASTA) type rotator cuff tear (13.5%),
or concomitant labral repair (11.0%). Patients with concomitant coracoplasty (2.3%)
or tears larger in size and/or involving more tendons were less likely (P < .05) to
develop postoperative stiffness. Among 90 patients positive for selected risk factors
(adhesive capsulitis, excision of calcific deposits, single-tendon repair, PASTA repair,
or any labral repair without a concomitant coracoplasty), 12 (13.3%) developed postoperative
stiffness (P < .001). This overall clinical risk factor combined with Workers' Compensation
insurance identified 16 of the 24 cases resulting in a sensitivity of 66.7% and a
specificity of 64.5%. All 24 patients who experienced postoperative stiffness elected
to undergo arthroscopic lysis of adhesions and capsular release, which was performed
from 4 to 19 months (median, 8 months) after the rotator cuff repair. During second-look
arthroscopy, 23 patients (95.8%) were noted to have complete healing of the original
pathology. Following capsular release, all 24 patients were satisfied with the overall
result of their treatment.
In a series of 489 consecutive arthroscopic rotator cuff repairs, we found that 24
patients (4.9%) developed postoperative stiffness. Risk factors for postoperative
stiffness were calcific tendinitis, adhesive capsulitis, single-tendon cuff repair,
PASTA repair, being under 50 years of age, and having Workers' Compensation insurance.
Twenty-three of 24 patients (95.8%) showed complete healing of the rotator cuff. Arthroscopic
release resulted in normal motion in all cases.
Level IV, therapeutic case series.