Risk Factors for Shoulder Stiffness After Rotator Cuff Repair: A Systematic Review and Meta-analysis

BACKGROUND: Shoulder stiffness after rotator cuff repair (RCR) represents a primary determinant of patient-reported quality of life. The implementation of predictive strategies for the early identification of risk factors is critical for mitigating this complication. PURPOSE: To evaluate the incidence of shoulder stiffness after RCR and to identify associated risk factors. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from database inception to February 28, 2025. Factors reported in ≥2 studies with extractable data underwent meta-analysis; otherwise, a qualitative synthesis was performed. Sensitivity analyses were executed for risk factors exhibiting substantial heterogeneity or potential reporting bias. Effect sizes for risk factors were calculated using odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: > .05). CONCLUSION: This study revealed a pooled incidence of 12.9% for stiffness after RCR, with notable variations observed across diagnostic criteria and follow-up durations. Additionally, older age, diabetes, fatty infiltration, and concomitant subacromial decompression were identified as significant risk factors for postoperative stiffness. Clinicians should prioritize recognizing these risk factors and implementing evidence-based preventive strategies to reduce the incidence of stiffness after RCR.