Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises
Lee BG, Cho NS, Rhee YG. Arthroscopy. 2012 Jan;28(1):34-42. Epub 2011 Oct 20. https://www.ncbi.nlm.nih.gov/pubmed/22014477
Rotator cuff tears are common injuries to the shoulder and typically require surgical repair. The success of the repair has had mixed results due to several controllable and uncontrollable factors. One factor that is controllable is the rehabilitation following surgery. It is currently not known if more early aggressive motion or a more limited early motion rehabilitation protocol is more effective for proper rotator cuff healing. Therefore, the objective of this study was to compare the clinical and structural outcome between 2 different rehabilitation protocols after arthroscopic single-row repair for full-thickness rotator cuff tears. Sixty-four patients with full-thickness rotator cuff repairs were randomly assigned to either the aggressive early passive rehabilitation group (immediate passive motion with no limitation; twice per day for 6 weeks) or the limited early passive rehabilitation group (minimum passive stretching to prevent joint stiffness; twice per day for 3 weeks). For the remaining 3 weeks both groups performed the same rehabilitation. Six weeks following surgery both groups received the same rehabilitation program, which progressed through shoulder strengthening and a return-to-activity protocol. Patients were examined for pain (visual analog score, VAS), shoulder range of motion (forward flexion, external rotation at side and 90°, internal rotation at 90°, and abduction), shoulder strength (same as range of motion), functional outcome questionnaire (University of California, Los Angeles score, UCLA), and structural tendon assessment (magnetic resonance imaging) pre-operatively and at 3, 6, and 12 months post-operatively. They found that pain significantly decreased and shoulder strength increased in both groups following surgery at all time points; however, there was no significant difference in pain between the groups. The aggressive group had larger amounts of shoulder range of motion at 3 and 6 months post-operatively; however, at one year follow-up there were no significant differences between the groups. For the UCLA score the aggressive group had significantly improved scores at 3 months post-operatively; however, at 6 and 12 months there were no group differences. When assessing the structural integrity of the tendon at 12 months post-operatively the aggressive group had a re-tear rate of 23.3% while the limited group had a re-tear rate of 8.8% (these findings were not statistically different).
Written by: Stephen Thomas
Reviewed by: Jeffrey Driban
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Lee BG, Cho NS, & Rhee YG (2012). Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy, 28 (1), 34-42 PMID: 22014477