Low early post-operative pain is a strong predictor of favorable outcomes after rotator cuff repair.

HYPOTHESIS AND/OR BACKGROUND: Post-operative pain following arthroscopic rotator cuff repair (ARCR) is highly variable. While some patients require strong analgesia, including opioids, others report minimal discomfort. Identifying predictors of low pain early after surgery may help tailor analgesic strategies and anticipate functional outcomes. This study aimed to identify independent predictors of low pain at one month after ARCR and to evaluate whether early low pain predicts a more favorable clinical course during the first post-operative year.

METHODS: A retrospective single-center, single-surgeon study included 178 patients who underwent primary ARCR between 2022 and 2023. Patients with partial or revision repairs, patch augmentation, tendon transfers, or isolated subscapularis tears were excluded. Low pain was defined as a visual analog scale (VAS) ≤3 at one month without analgesic use. Multivariate logistic regression identified predictors of low pain. Clinical outcomes (Constant score, American Shoulder and Elbow Surgeons, Subjective Shoulder Value, range of motion, strength, and VAS), return to work/sport, complications, and revisions were compared between patients with and without low pain. Propensity score matching (1:1) was performed to reduce confounding.

RESULTS: Three independent predictors of low pain at one month were identified: absence of subscapularis tendon involvement (P = .03), absence of pre-operative analgesic use (P = .001), and lower baseline VAS pain score (P = .049). Patients with low pain at one month (n = 58; 32.6%) had significantly higher Constant, American Shoulder and Elbow Surgeons, and Subjective Shoulder Value scores, as well as lower VAS pain at all post-operative time points up to 1 year (P < .05 for all). At 1 year, between-group differences exceeded the Minimal Clinically Important Difference for all patient-reported outcome measures. No differences were observed in return-to-work, return-to-sport, complication, or revision rates.

CONCLUSION: Low pain at 1 month after ARCR was independently associated with absence of subscapularis involvement, absence of pre-operative analgesic use, and lower baseline pain. Patients experiencing early low pain follow a consistently more favorable clinical trajectory, achieving superior functional outcomes throughout the first post-operative year.