Postoperative shoulder stiffness is a frequent complication after arthroscopic rotator cuff repair (RCR) and may delay early recovery. The influence of preoperative mobility, rehabilitation strategy, and immobilization position on postoperative stiffness and functional outcomes remains debated.

Preoperative limitation of shoulder mobility and early postoperative stiffness influence mid-term functional recovery, and supervised self-rehabilitation may reduce early stiffness compared with classical physiotherapy.

A retrospective cohort of 362 patients undergoing arthroscopic RCR was analyzed. Shoulder stiffness was defined as passive forward flexion <120 ° combined with passive external rotation <30 °. In addition, a relative analysis based on forward flexion loss ≥10 ° compared with the contralateral shoulder was performed. Patients were evaluated at 1, 6, and 12 months using range of motion, Constant score, and Subjective Shoulder Value (SSV). Rehabilitation type and immobilization position were recorded.

Preoperative limitation ≥10 ° was observed in 139 patients (38%). It was significantly associated with increased postoperative stiffness at 1 and 6 months (p < 0.05), but not with differences in Constant score or SSV at 6 or 12 months. Persistent stiffness at 6 months was associated with inferior Constant score and SSV at 12 months (p < 0.01). Patients who followed supervised self-rehabilitation demonstrated lower stiffness rates at 1 month and better functional classification at 6 months compared with those receiving active physiotherapy (p < 0.0002). Immobilization at 20 ° of abduction was associated with higher early stiffness compared with 60 ° (p = 0.022).

In conclusion, preoperative limitation predicts early postoperative stiffness but does not compromise mid-term functional outcomes after arthroscopic rotator cuff repair. Persistent stiffness at six months is associated with inferior one-year results. Patients who followed supervised self-rehabilitation according to the Liotard protocol experienced less early postoperative stiffness and better short-term functional classification than those who received additional active physiotherapy. Structured, patient-controlled rehabilitation appears to support functional recovery while respecting tendon protection principles.

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