Recovery After Arthroscopic Rotator Cuff Repair With or Without Capsular Release in Patients With Preoperative Stiffness: A Cohort Study

Preoperative shoulder stiffness may delay functional recovery after arthroscopic rotator cuff repair, but the incremental value of concomitant capsular release remains uncertain. This retrospective comparative cohort study evaluated 124 patients with reparable rotator cuff tears and preoperative stiffness who underwent arthroscopic repair with concomitant capsular release (CR group, n = 62) or without capsular release (No CR group, n = 62). Shoulder function, pain, active forward elevation, and active external rotation were assessed preoperatively and at 3, 6, and 12 months postoperatively. Additional outcomes included estimated time to functional range of motion, persistent stiffness, secondary stiffness-related interventions, patient satisfaction, complications, and repair integrity on 12-month magnetic resonance imaging. Multivariable analyses were used to account for measured baseline differences associated with nonrandom treatment allocation. Compared with the CR group, the No CR group had a 3.71-point lower adjusted American Shoulder and Elbow Surgeons score at 6 months and had a 3.80-week longer estimated time to functional range of motion. Any secondary stiffness-related intervention was required in 1.6% of the CR group and 16.1% of the No CR group. Persistent stiffness and retear were numerically less frequent in the CR group, but the adjusted associations were not statistically significant. By 12 months, functional outcomes had largely converged. Concomitant capsular release was associated primarily with earlier recovery and a lower stiffness-related treatment burden rather than superior final functional status. No statistically significant increase in retear was observed at 12 months, but the small number of events limits conclusions regarding structural safety.