Risk Factors of Postoperative Shoulder Stiffness After Rotator Cuff Repair: A Systematic Review and Meta-Analysis.

IF 2.8 Q2 SURGERY

JBJS Reviews Pub Date : 2025-10-24 eCollection Date: 2025-10-01 DOI:10.2106/JBJS.RVW.25.00134

Songci Wang, Pu Zhang, Jianhao Xie, Chunyan Jiang

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Abstract

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.

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肩袖修复术后肩僵硬的危险因素：系统回顾和荟萃分析。

背景：肩袖修复是治疗肩袖撕裂（rct）的一种常见且有效的方法。同时，术后肩僵硬（PSS）仍是常见的不良并发症，严重影响患者术后恢复和生活质量。现有研究对PSS危险因素的研究结果不一致，需要进行系统的定量分析。本研究旨在通过系统综述和荟萃分析，明确RCT后PSS的危险因素，为临床实践提供循证依据。方法：检索PubMed、EMBASE、Cochrane和Web of Science数据库，检索时间从数据库建立之日至2024年11月。纳入了符合标准的队列研究和病例对照研究。提取相关危险因素及其效应量。采用Stata/SE 17.0进行meta分析，根据异质性水平选择固定效应或随机效应模型。进行亚组分析、敏感性分析和发表偏倚评价。结果：纳入18项研究，涉及63565例患者，分析了20个潜在危险因素。其中，年龄（平均差值0.23,95%可信区间[CI] 0.03 ~ 0.43, p = 0.027）、女性（比值比[OR] 1.99, 95% CI 1.69 ~ 2.32, p < 0.001）、糖尿病（OR 2.01, 95% CI 1.15 ~ 3.52, p = 0.015）、甲状腺疾病（OR 1.32, 95% CI 1.09 ~ 1.59, p = 0.004）、工伤保险（OR 1.92, 95% CI 1.10 ~ 3.37, p = 0.022）与PSS相关。亚组分析显示，非亚洲人群中的女性（OR 2.17, 95% CI 1.66-2.84, p < 0.001）和随访超过3个月的患者术前肩僵硬度（OR 1.64, 95% CI 1.03-2.60, p = 0.035）与PSS显著相关。结论：RCT术后PSS受多种因素影响。根据目前的证据，高龄、女性、糖尿病、甲状腺疾病和工伤保险是高危因素。临床应注意术前综合评估和个体化管理策略，特别是高危人群围手术期应加强干预。证据等级：v级。参见《作者说明》获得证据等级的完整描述。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.