Recovery Trajectory of Range of Motion and Its Association With Patient Factors During Early Postoperative Stiffness After Arthroscopic Rotator Cuff Repair
Orthopaedic journal of sports medicine · 2026
Nearly half of cuff repair patients have early stiffness, and those whose stiffness is pain-driven (not fear-driven) are the ones likely to stay stiff at 6 months.
De studie
Retrospective cohort, n=352 patients who underwent arthroscopic complete repair of full-thickness rotator cuff tears.
Wat ze vonden
46.9% (165/352) met stiffness criteria at 3 months; among these, 20.6% (34/165) had persistent stiffness at 6 months. Higher VAS pain at 3 months independently predicted persistence (OR 1.44, 95% CI 1.01-2.05, P=.044). Fear/anxiety about retear was the most common reported barrier to rehab overall (50.3%) but was largely reversible; pain was a less common barrier (32.7%) but was over-represented among patients who went on to have persistent stiffness, cited by 67.6% of that group. Note this 67.6% figure describes the composition of the persistent-stiffness group, not a persistence rate conditional on having pain as the barrier, so it shouldn't be read as 'two-thirds of pain-driven patients stay stiff.'
Studieopzet
Single-centre retrospective cohort study, Level of evidence 3, n=352, patients who underwent arthroscopic repair of full-thickness rotator cuff tears at what appears to be one institution.
Methodologie
This is retrospective chart review with all the usual limitations: no protocolised rehab standardisation described, no blinding of ROM/outcome assessors, and the 'primary barrier to rehabilitation' at 3 months is a single self-reported item with no validated instrument or details on how it was elicited, so recall and reporting bias are real risks. The OR of 1.44 has a CI that only just clears 1 (1.01-2.05) and the P value is.044, meaning this is a fragile, borderline-significant finding in a multivariate model whose other covariates and adjustment quality aren't described in the abstract. No mention of loss to follow-up, inter-rater reliability for ROM measurement, or external validation, and single-surgeon/single-centre cohorts often don't generalise to other rehab protocols.
De beoordeling
The OR of 1.44 per unit VAS increase is statistically significant but barely so, and translating a VAS-score odds ratio into a clinically meaningful prediction rule is not straightforward; the abstract offers no sensitivity/specificity or a usable pain cutoff a clinician could act on at 3 months. The design is associative, not causal, so this identifies a possible marker of persistent stiffness rather than proving pain drives it, and the interesting qualitative observation (fear-avoidance is common but reversible, pain-driven stiffness persists) is descriptive rather than tested against a comparator.
De beperking
The primary barrier variable is a single retrospective self-report with no described measurement method, and the predictive model isn't validated or given a clinically usable threshold, so you cannot yet tell a patient with X pain score they have Y% risk of persistent stiffness.
Referentiestudie
This sits within the existing literature on stiffness incidence after arthroscopic rotator cuff repair and early passive ROM protocols; it adds a pain-versus-fear phenotyping angle to that picture rather than overturning established early mobilisation evidence.
Wat te doen op maandag
In the subset of patients still meeting stiffness criteria at 3 months (roughly half of repairs), use pain as a soft flag: those citing pain rather than fear/anxiety as their main barrier are the ones more likely to remain stiff at 6 months, so escalate pain management and desensitisation-focused rehab for that group rather than just pushing harder into stretch. This doesn't yet justify a new screening tool or a formal protocol change given the borderline statistics (OR CI 1.01-2.05) and single retrospective cohort.
In practice
Applies to the roughly half of arthroscopic cuff repair patients still meeting stiffness criteria at 3 months, not to routine post-op shoulders generally. In clinic, use the 3-month review to ask what's actually limiting movement: fear/anxiety about the repair responds to reassurance and graded exposure and usually resolves on its own, but a patient who names pain as the main barrier needs escalated pain control and desensitisation work rather than more aggressive stretching, since that's the subgroup still stiff at 6 months. Track recovery with serial Flexion, External rotation and Internal rotation measures (the same thresholds the study used to define stiffness) at 3 and 6 months so escalation is triggered by numbers rather than how the shoulder feels that day. For S&C coaches picking these athletes up for return-to-performance work, treat a pain-driven stiff shoulder as the one to slow down on overhead or pressing progression while a fear-driven stiff shoulder mainly needs confidence-building load exposure; either way this is a weak, single-cohort signal (OR CI 1.01-2.05), so use it to prioritise conversations, not as a formal gate.
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