Attention-Deficit/Hyperactivity Disorder Is Associated With Lower Rates of Adhesive Capsulitis, Bursitis, Shoulder Stiffness, and Revision Shoulder Arthroscopy After Arthroscopic Rotator Cuff Repair
Kyle N. Zelenski, Jared Sasaki, Navkiran Bedi, Alex Chelton, Alexander J. MacFarlane, Matthew G. Alben, Samuel I. FullerBackground:
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.
Study Design:
Retrospective cohort study.
Level of Evidence:
Level 3.
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;
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.