Summary
A prospective, randomized study of 70 patients determined the effect of 2 rehabilitation protocols on repair integrity and motion following arthroscopic cuff repair. The only difference between protocols was that passive forward elevation began on post-op day #7 in the Standard group and after 4 weeks in the Decelerated group. Patients underwent ultrasound at 1, 2, 3, and 6 months. For post-op ROM, no significant difference was found between groups. At 6 months, 81% of cuffs were intact for the Standard group vs. 91% for the Decelerated group. (p>0.05) The decelerated rehabilitation protocol resulted in fewer re-tears without postoperative stiffness.
Purpose
The effects of rehabilitation on repair integrity following arthroscopic cuff repair have been poorly studied. A prospective, randomized study was carried out in order to determine the effect of 2 different rehabilitation protocols on structural integrity and range of motion (ROM) following arthroscopic cuff repair.
Methods
Seventy patients undergoing arthroscopic rotator cuff repair were randomized to either a Standard (37 patients) or Decelerated (33 patients) rehabilitation protocol. The average age (57 years; range: 29-78 years) and intraoperative tear size were similar for both groups. All repairs were performed by the senior author with a single row of metal anchors with simple sutures. All patients were immobilized in an ultrasling for 6 weeks. For both groups, pendulum exercises were initiated on post-op day #1, supine passive external rotation stretches on post-op day #7, and passive internal rotation stretches at 4 weeks. The only difference between groups was that supine passive forward elevation exercises were started on post-op day #7 in the Standard group and after 4 weeks in the Decelerated group. The strengthening phase was identical for both groups. All patients underwent post-op range of motion measurement and ultrasonography of the shoulder at 1 month, 2 months, 3 months, and 6 months. Dynamic images were reviewed by the senior author and 2 blinded musculoskeletal radiologists. Interobserver reliability was calculated. Chi-square and Student t test were used to determine whether a significant difference could be found between groups with respect to the number of re-tears and postoperative ROM.
Results
For postoperative ROM, no significant difference was found between groups at any of the time intervals. Interobserver reliability for the ultrasound readings was good to excellent with a Kappa value of 0.834. At 6 months, 81% (30/37) of cuffs were intact for the Standard group vs. 91% (30/33) for the Decelerated group. (p>0.05) For both groups, 35% (8/23) of large to massive tears were re-torn vs. 4% (2/47) of small to medium tears. (p<0.05) There was a trend for re-tears to occur in older patients: re-tear, 62y vs. intact, 56y. (p=0.11).
Conclusions
A statistically significant difference was not found between the re-tear rates in the Standard and Decelerated groups (19% vs. 9%); however this difference may be clinically relevant. This study supports the use of a decelerated rehabilitation protocol following arthroscopic cuff repair because it resulted in fewer re-tears and was not associated with postoperative stiffness.
Article info
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
