Psychosocial factors associated with postoperative outcomes after arthroscopic rotator cuff repair

Abstract

Background

Arthroscopic rotator cuff repair (ARCR) is a common treatment for rotator cuff tears with postoperative outcomes being influenced by multiple factors. Patient characteristics and surgical techniques are well-documented associated with postoperative outcomes; however, the role of psychosocial factors, including pain catastrophizing, kinesiophobia, and pain self-efficacy, in influencing postoperative functional outcomes remains unclear. The present study explores whether psychosocial factors are associated with postoperative outcomes following ARCR.

Methods

This retrospective study included patients who underwent ARCR for full-thickness supraspinatus tears between January 2022 and May 2024. Comprehensive data were collected before and after surgery, including patient demographics, characteristics of the tendon lesion, surgical techniques, and psychosocial factors evaluated using the Tampa Scale for Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), and Pain Self-Efficacy Questionnaire. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score. Multiple linear regression analysis was conducted to evaluate the association between patient demographics, characteristics of the tendon lesion, surgical techniques, psychosocial factors, preoperative ASES scores, and the postoperative ASES scores.

Results

Significant improvements were observed postoperatively in ASES, TSK-11, PCS, and Pain Self-Efficacy Questionnaire scores (P < .01, all). Multiple linear regression analysis identified male sex, absence of diabetes, repair technique, higher preoperative ASES scores, and lower TSK-11 and PCS scores as variables independently associated with higher postoperative ASES scores. The model accounted for approximately 10% of the variance in postoperative ASES scores (adjusted R² = 0.10, P < .01).

Conclusion

This study suggests a potential association between psychosocial factors—such as kinesiophobia and pain catastrophizing—and functional recovery after ARCR. Although causality cannot be inferred, these associations highlight the potential clinical relevance of psychosocial factors in postoperative recovery. Poorer psychological scores, including high TSK-11 and PCS scores, were associated with lower postoperative outcomes. Further investigation is needed to explore how interventions targeting these psychosocial factors can enhance recovery and patient satisfaction.