Purpose
To compare range of motion and healing rates between 2 different rehabilitation protocols
after arthroscopic single-row repair for full-thickness rotator cuff tear.
Methods
Sixty-four shoulders available for postoperative magnetic resonance imaging (MRI)
evaluation after arthroscopic rotator cuff repair were enrolled in this study. Aggressive
early passive rehabilitation (manual therapy [2 times per day] and unlimited self–passive
stretching exercise) was performed in 30 shoulders (group A) and limited early passive
rehabilitation (limited continuous passive motion exercise and limited self–passive
exercise) in 34 shoulders (group B). A postoperative MRI scan was performed at a mean
of 7.6 months (range, 6 to 12 months) after surgery.
Results
Regarding range of motion, group A improved more rapidly in forward flexion, external
rotation at the side, internal and external rotation at 90° of abduction, and abduction
than group B until 3 months postoperatively with significant differences. However,
there were no statistically significant differences between the 2 groups at 1-year
follow-up (P = .827 for forward flexion, P = .132 for external rotation at the side, P = .661 for external rotation at 90° of abduction, and P = .252 for abduction), except in internal rotation at 90° of abduction (P = .021). In assessing the repair integrity with postoperative MRI scans, 7 of 30
cases (23.3%) in group A and 3 of 34 cases (8.8%) in group B had retears, but the
difference was not statistically significant (P = .106).
Conclusions
Pain, range of motion, muscle strength, and function all significantly improved after
arthroscopic rotator cuff repair, regardless of early postoperative rehabilitation
protocols. However, aggressive early motion may increase the possibility of anatomic
failure at the repaired cuff. A gentle rehabilitation protocol with limits in range
of motion and exercise times after arthroscopic rotator cuff repair would be better
for tendon healing without taking any substantial risks.
Level of Evidence
Level II, randomized controlled trial.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.J Bone Joint Surg Am. 2004; 86: 219-224
- Arthroscopic rotator cuff repair: 4- to 10-year results.Arthroscopy. 2004; 20: 5-12
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.J Shoulder Elbow Surg. 2007; 16: 461-468
- A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: Magnetic resonance imaging and early clinical evaluation.Am J Sports Med. 2009; 37: 674-682
- Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial.Am J Sports Med. 2007; 35: 1254-1260
- Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair?.Am J Sports Med. 2007; 35: 1247-1253
- Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study.J Shoulder Elbow Surg. 2006; 15: 290-299
- Technical pearls on how to maximize healing of the rotator cuff.Instr Course Lect. 2007; 56: 3-12
- Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.J Bone Joint Surg Am. 1984; 66: 563-567
- Fatty muscle degeneration in cuff ruptures.Clin Orthop Relat Res. 1994; : 78-83
- Diagnosis and treatment of anterosuperior rotator cuff tears.J Shoulder Elbow Surg. 2001; 10: 37-46
- The ‘three sister portals’ for arthroscopic repair of massive rotator cuff tears.Tech Shoulder Elbow Surg. 2007; 8: 53-57
- MR imaging of the shoulder after rotator cuff repair.AJR Am J Roentgenol. 1997; 168: 559-563
- Arthroscopic rotator cuff repair: Prospective functional outcome and repair integrity at minimum 2-year follow-up.J Shoulder Elbow Surg. 2007; 16: 579-585
- Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: A magnetic resonance imaging-controlled matched-pair analysis.Arthroscopy. 2007; 23: 514-521
- Rehabilitation of the rotator cuff: An evaluation-based approach.J Am Acad Orthop Surg. 2006; 14: 599-609
- Operative treatment of failed repairs of the rotator cuff.J Bone Joint Surg Am. 1992; 74: 1505-1515
- Arthroscopic repair of full-thickness tears of the supraspinatus: Does the tendon really heal?.J Bone Joint Surg Am. 2005; 87: 1229-1240
- Mechanical strength of repairs of the rotator cuff.J Bone Joint Surg Br. 1994; 76: 371-380
- Arthroscopic placement of a modified Mason-Allen stitch.Arthroscopy. 2006; 22: 1248.e1-1248.e3
- The strength of suture configurations in arthroscopic rotator cuff repair.Arthroscopy. 2006; 22: 837-841
- The results of repair of massive tears of the rotator cuff.J Bone Joint Surg Am. 2000; 82: 505-515
- Tendon to bone healing: Differences in biomechanical, structural, and compositional properties due to a range of activity levels.J Biomech Eng. 2003; 125: 106-113
- Complete removal of load is detrimental to rotator cuff healing.J Shoulder Elbow Surg. 2009; 18: 669-675
- Stress distribution in the supraspinatus tendon after tendon repair: Suture anchors versus transosseous suture fixation.Am J Sports Med. 2007; 35: 542-546
- Mode of failure for rotator cuff repair with suture anchors identified at revision surgery.J Shoulder Elbow Surg. 2003; 12: 128-133
- The biomechanical effects of dynamic external rotation on rotator cuff repair compared to testing with the humerus fixed.Am J Sports Med. 2007; 35: 1931-1939
- Experimental rotator cuff repair.J Bone Joint Surg Am. 1999; 81: 1281-1290
- Repair site integrity after arthroscopic transosseous-equivalent suture-bridge rotator cuff repair.Am J Sports Med. 2008; 36: 1496-1503
Article info
Publication history
Published online: October 21, 2011
Accepted:
July 19,
2011
Received:
September 26,
2010
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
