Careful with that motion: A prospective cohort study evaluating the relationship of passive shoulder motion on repair integrity in 136 consecutive arthroscopic rotator cuff repairs

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Abstract
Background: Retear is the most common complication following arthroscopic rotator cuff repair. Reduced early shoulder motion is associated with lower retear rates, but previous studies dichotomised shoulders at chosen cut-points. Whether retear risk changes at a discrete threshold or rises continuously is unknown. Methods: In this prospective cohort study, 136 patients underwent primary arthroscopic supraspinatus repair by a single surgeon. Passive range of motion and patient-reported stiffness was recorded preoperatively, at 6, 12 and 24 weeks. Repair integrity was assessed by ultrasound at 6 months. Firth penalised logistic regression, restricted cubic splines and changepoint regression were used for statistical analysis. Results: Eighteen patients (13%) sustained a retear. Greater forward flexion, abduction and global range of motion at 6 and 12 weeks were associated with retear (p = 0.002–0.026), independent of tear size. No changepoint or non-linearity was detected. Predicted retear risk rose from 4% to 6% at 60° to 21% to 26% at 150°. Patients reporting no stiffness at 6 weeks had a retear rate of 26%, compared with 4% among those reporting any stiffness. Discussion: Greater passive shoulder motion early after rotator cuff repair was associated with a higher risk of retear, and the risk rose progressively across the full range of motion.

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