Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Prediction of shoulder stiffness after arthroscopic rotator cuff repair
Authors: Audigé, Laurent
Aghlmandi, Soheila
Grobet, Cécile
Stojanov, Thomas
Müller, Andreas M.
Felsch, Quinten
Gleich, Johannes
Flury, Matthias
Scheibel, Markus
et. al: No
DOI: 10.1177/03635465211028980
Published in: The American Journal of Sports Medicine
Volume(Issue): 49
Issue: 11
Page(s): 3030
Pages to: 3039
Issue Date: 2021
Publisher / Ed. Institution: Sage
ISSN: 0363-5465
Language: English
Subjects: Capsulitis; Arthroscopy; Case-Control study; Retrospective study; Rotator cuff tear; Surgery; Complication; Shoulder stiffness; Frozen shoulder; Risk factor; Prediction; Discrimination; Registry Database
Subject (DDC): 617.5: Orthopaedic surgery
Abstract: Background: Postoperative shoulder stiffness (POSS) is a prevalent adverse event after arthroscopic rotator cuff repair (ARCR) that is associated with major limitations in everyday activities and prolonged rehabilitation. Purpose/Hypothesis: The purpose was to develop a predictive model for determining the risk of POSS within 6 months after primary ARCR. We hypothesized that sufficient discrimination ability of such a model could be achieved using a local institutional database. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive primary ARCRs documented in a local clinical registry between 2013 and 2017 were included, and patients who experienced POSS before the final clinical 6-month follow-up were identified. A total of 29 prognostic factor candidates were considered, including patient-related factors (n = 7), disease-related factors (n = 9), rotator cuff integrity factors (n = 6), and operative details (n = 7). We used imputed data for the primary analysis, and a sensitivity analysis was conducted using complete case data. Logistic regression was applied to develop a model based on clinical relevance and statistical criteria. To avoid overfitting in the multivariable model, highly correlated predictors were not included together in any model. A final prognostic model with a maximum of 8 prognostic factors was considered. The model’s predictive accuracy was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping. Results: Of 1330 ARCR cases (N = 1330 patients), 112 (8.4%) patients had POSS. Our final model had a moderate predictive ability with an AUC of 0.67. The predicted risks of POSS ranged from 2.3% to 38.9% and were significantly higher in women; patients with partial tears, low baseline passive shoulder abduction, and lack of tendon degeneration; and when no acromioplasty was performed. Conclusion: A prognostic model for POSS was developed for patients with ARCR, offering a personalized risk evaluation to support the future decision process for surgery and rehabilitation.
Fulltext version: Published version
License (according to publishing contract): Licence according to publishing contract
Departement: School of Management and Law
Organisational Unit: Winterthur Institute of Health Economics (WIG)
Appears in collections:Publikationen School of Management and Law

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