Effect of adhesion barrier injection on the prevention of postoperative stiffness after arthroscopic rotator cuff repair: a meta-analysis

This meta-analysis aimed to systematically assess the clinical efficacy of adhesion barriers in improving shoulder range of motion and function and reducing pain after arthroscopic rotator cuff repair. PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Embase, and Web of Science were searched from inception through February 2026 for comparative clinical studies of postoperative adhesion barrier injection versus no injection. Outcomes included shoulder range of motion (ROM), Constant-Murley score, American Shoulder and Elbow Surgeons score (ASES), and visual analog scale (VAS) pain score. Risk of bias and methodological quality were assessed using the Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE). Continuous outcomes were pooled as mean differences (MD) with 95% confidence intervals (CIs) using Review Manager 5.3. Six studies were included, comprising three randomized controlled trials, one prospective cohort study, and two retrospective comparative studies, with a total of 712 patients: 325 in the injection group and 387 in the control group. At 3 months, the injection group showed greater forward flexion than the control group (MD = 11.96, 95% CI: 5.47 to 18.44, P = 0.0003), whereas external rotation at the side did not differ significantly (MD = 3.08, 95% CI: −2.59 to 8.74, P = 0.29). At final follow-up, the injection group had higher Constant-Murley and ASES scores, but no significant between-group differences were observed in range of motion or pain. Certainty of evidence was very low for all outcomes. Postoperative adhesion barrier injection was associated with greater forward flexion at 3 months and higher functional scores at the final follow-up. However, the point estimates for the functional-score differences were below the reported minimal clinically important difference (MCID) values, benefits were not consistent across other range-of-motion or pain outcomes, and the certainty of evidence was very low. Current evidence therefore does not support the routine use of adhesion barrier injection after arthroscopic rotator cuff repair. The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on March 25, 2026 (CRD420261341499). The final systematic search was performed after protocol registration and included studies published from database inception through February 2026. Not applicable.