Prevalence and risk factors of shoulder stiffness after rotator cuff repair: a meta-analysis.
This meta-analysis aims to determine the prevalence of postoperative shoulder stiffness (PSS) after rotator cuff repair surgery and to explore its potential risk factors.
Search the PubMed, Embase, Web of Science, and Cochrane Library databases from their inception to July 1, 2025, for all studies reporting the prevalence of PSS after rotator cuff repair surgery and its associated risk factors. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was performed using Stata 15.0 software.
Eight cohort studies involving 21,033 patients were included. The pooled prevalence of postoperative shoulder stiffness (PSS) after rotator cuff repair was 17% (95% CI: 9%-24%), with substantial heterogeneity (I2 = 98.2%). Subgroup analysis by continent showed variation in reported prevalence estimates across regions, although these findings should be interpreted cautiously because some subgroups were based on a limited number of studies. Additional subgroup analyses according to sample size, publication year, and mean age were conducted to explore heterogeneity. In the sample size subgroup analysis, the pooled prevalence was 14% (95% CI: 2%-25%) in studies with a sample size ≥ 300 and 18% (95% CI: 15%-21%) in studies with a sample size < 300, with lower heterogeneity in the latter subgroup. By contrast, subgroup analyses by publication year and mean age did not materially reduce heterogeneity. In pooled analyses of adjusted effect estimates, age < 50 years (OR = 1.09, 95% CI: 1.03-1.15), female sex (OR = 1.66, 95% CI: 1.03-2.68), and diabetes mellitus (OR = 2.73, 95% CI: 1.75-4.26) were associated with PSS; however, the effect size for age < 50 years was small.
PSS after rotator cuff repair is not uncommon, but the pooled prevalence should be interpreted cautiously because of substantial heterogeneity and inconsistent diagnostic definitions across studies. Female sex and diabetes mellitus may be associated with PSS, whereas the clinical relevance of the association with age < 50 years appears limited. Further high-quality prospective studies are required.
Search the PubMed, Embase, Web of Science, and Cochrane Library databases from their inception to July 1, 2025, for all studies reporting the prevalence of PSS after rotator cuff repair surgery and its associated risk factors. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Meta-analysis was performed using Stata 15.0 software.
Eight cohort studies involving 21,033 patients were included. The pooled prevalence of postoperative shoulder stiffness (PSS) after rotator cuff repair was 17% (95% CI: 9%-24%), with substantial heterogeneity (I2 = 98.2%). Subgroup analysis by continent showed variation in reported prevalence estimates across regions, although these findings should be interpreted cautiously because some subgroups were based on a limited number of studies. Additional subgroup analyses according to sample size, publication year, and mean age were conducted to explore heterogeneity. In the sample size subgroup analysis, the pooled prevalence was 14% (95% CI: 2%-25%) in studies with a sample size ≥ 300 and 18% (95% CI: 15%-21%) in studies with a sample size < 300, with lower heterogeneity in the latter subgroup. By contrast, subgroup analyses by publication year and mean age did not materially reduce heterogeneity. In pooled analyses of adjusted effect estimates, age < 50 years (OR = 1.09, 95% CI: 1.03-1.15), female sex (OR = 1.66, 95% CI: 1.03-2.68), and diabetes mellitus (OR = 2.73, 95% CI: 1.75-4.26) were associated with PSS; however, the effect size for age < 50 years was small.
PSS after rotator cuff repair is not uncommon, but the pooled prevalence should be interpreted cautiously because of substantial heterogeneity and inconsistent diagnostic definitions across studies. Female sex and diabetes mellitus may be associated with PSS, whereas the clinical relevance of the association with age < 50 years appears limited. Further high-quality prospective studies are required.