|Publication type:||Article in scientific journal|
|Type of review:||Peer review (publication)|
|Title:||Prediction of shoulder stiffness after arthroscopic rotator cuff repair|
Müller, Andreas M.
|Published in:||The American Journal of Sports Medicine|
|Publisher / Ed. Institution:||Sage|
|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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