The presence of gastroesophageal reflux disease increases the risk of developing post-operative shoulder stiffness after arthroscopic rotator cuff repair

Purpose: Postoperative shoulder stiffness (SS) after arthroscopic rotator cuff (RC) repair has been reported with variable incidence and numerous preoperative risk factors have been described. This prospective study aims to document the incidence of postoperative SS and to evaluate the role of preoperative risk factors in the development of this complication, with special focus on the role of gastroesophageal reflux disease (GERD). Methods: Preoperative risk factors for SS were prospectively evaluated in 237 consecutive patients undergoing single-row arthroscopic RC repair. The presence of GERD was evaluated with the GerdQ diagnostic tool. Postoperative SS was diagnosed according to the criteria described by Brislin and colleagues in 2007. Results: The incidence of postoperative SS was 8.02%. The presence of GERD was significantly associated with development of postoperative SS (OR: 5.265; 95% CI, 1.657-1.731; p=0.005). Older age (OR: 0.896; 95% CI, 0.847-0.949; p<0.001), male gender (OR: 0.126; 95% CI, 0.0252-0.632; p=0.012) and number of pregnancies (OR: 0.47; 95% CI, 0.228-0.967; p=0.040) emerged as protective factors. Conclusions: The presence of GERD significantly influences the development of postoperative SS after single-row arthroscopic RC repair. An underlying a specific pro-inflammatory condition, characterized by increased expression of TNF-\u3b1 and TGF-\u3b2, and disorders in retinoid metabolism are hypothesis which could explain this previously unknown association. The documented incidence of postoperative SS falls among previously reported ranges, with females significantly more affected than men