Risk factors for arthroscopic surgical outcomes in patients with rotator cuff tears based on LASSO regression analysis and construction of a predictive model

Rotator cuff tear outcomes after arthroscopic repair vary considerably. Reliable individualized risk prediction tools remain limited. This study identified independent risk factors for poor outcomes after arthroscopic rotator cuff repair and developed a predictive nomogram. This retrospective study included 183 patients (January 2021–December 2023) with MRI-confirmed rotator cuff tear, complete data, and > 6 months follow-up. Exclusion criteria: malignancy, severe cardiocerebrovascular/hepatorenal diseases, prior shoulder trauma, glenohumeral arthritis, or neurological impairment. All underwent standardized suture-bridge double-row repair. Poor outcome: NEER score ≤ 79 at 8 months. LASSO followed by multivariate logistic regression identified independent risk factors. A nomogram was constructed and assessed by AUC, calibration, Hosmer–Lemeshow test, and decision curve analysis with 1000 Bootstrap resamples. Poor outcomes occurred in 52 patients (28.4%). Independent risk factors: Thomazeau grade 2–3 (OR = 3.087), Goutallier grade ≥ 2 (OR = 3.023), greater tuberosity angle (OR = 1.454), greater tuberosity notch angle (OR = 1.131), preoperative VAS (OR = 1.201), and PSQI (OR = 1.322), all P < 0.05. The nomogram demonstrated good discrimination (AUC = 0.865, 95% CI: 0.805–0.924) and calibration (Hosmer–Lemeshow P = 0.091). Internal validation confirmed stability, with an acceptable net clinical benefit. Thomazeau grade 2–3, Goutallier grade ≥ 2, greater tuberosity angle, greater tuberosity notch angle, preoperative VAS score, and PSQI score are independent risk factors for poor outcomes after arthroscopic rotator cuff repair. The nomogram facilitates early identification of high-risk patients and may guide individualized management.