Attention-Deficit/Hyperactivity Disorder Is Associated With Lower Rates of Adhesive Capsulitis, Bursitis, Shoulder Stiffness, and Revision Shoulder Arthroscopy After Arthroscopic Rotator Cuff Repair.

BACKGROUND: Arthroscopic rotator cuff repair (RCR) success is dependent on adherence to a structured postoperative rehabilitation protocol. Attention-deficit/hyperactivity disorder (ADHD) is associated with worse outcomes after certain orthopaedic surgeries, but its impact on rehabilitation after RCR remains unclear. This study compared short-term outcomes after arthroscopic RCR in patients with and without ADHD.

HYPOTHESIS: Patients with ADHD will experience higher rates of postoperative complications within the first 12 months after arthroscopic RCR.

METHODS: Using the TriNetX Research Network, arthroscopic RCR cases from 113 healthcare organizations between January 2006 and January 2026 were identified and stratified by a preoperative ADHD diagnosis. Cohorts were propensity score-matched 1:1 for age, sex, obesity, type 2 diabetes mellitus, mood disorders, anxiety and stress-related disorders, and nicotine dependence. Outcomes at 3 months included revision shoulder arthroscopy, adhesive capsulitis, bursitis, and shoulder stiffness; 1-year outcomes also included deep infection and wound disruption. A Benjamini-Hochberg (BH) correction was applied to address multiple comparisons.

RESULTS: After propensity score matching, 4740 patients were included per cohort. At 3 months, patients with ADHD demonstrated lower odds of bursitis (odds ratio [OR], 0.733; 95% CI, 0.592-0.908; P = 0.004; BH-adjusted P = 0.009) and shoulder stiffness (OR, 0.729; 95% CI, 0.629-0.844; P < 0.001; BH-adjusted P < 0.001). At 1 year, the ADHD cohort demonstrated lower odds of revision shoulder arthroscopy (OR, 0.798; 95% CI, 0.655-0.972; P = 0.03; BH-adjusted P = 0.04), adhesive capsulitis (OR, 0.676; 95% CI, 0.550-0.831; P < 0.001; BH-adjusted P < 0.001), bursitis (OR, 0.681; 95% CI, 0.578-0.802; P < 0.001; BH-adjusted P < 0.001), and shoulder stiffness (OR, 0.716; 95% CI, 0.625-0.820; P < 0.001; BH-adjusted P < 0.001).

CONCLUSION: ADHD was associated with lower 3-month rates of bursitis and shoulder stiffness, and lower 1-year rates of adhesive capsulitis, bursitis, shoulder stiffness, and revision shoulder arthroscopy after arthroscopic RCR.

CLINICAL RELEVANCE: In contrast to previous literature, ADHD was not associated with worse outcomes after arthroscopic RCR and was associated with lower rates of stiffness-related complications. These findings suggest further research is needed to inform patient counseling and surgical decision-making.

STUDY DESIGN: Retrospective cohort study.

LEVEL OF EVIDENCE: Level 3.