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Rotator Cuff Repair and Immobilization
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Posted on: 05/13/2014
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Shoulder rotator cuff repair aims to suture torn rotator cuff tendons and provide them with the optimal environment to heal and minimize chance of retear. Overall retear rates have decreased over the years, but are still a major concern. Better suture techniques have been thoroughly investigated but there is less attention paid to the rehabilitation protocol. Currently the gold standard for rehabilitation after surgery is to wear an abduction brace and begin physical therapy for passive range of motion within the first few weeks. As surgical techniques have evolved from open surgery to arthroscopic surgery, there are questions as to whether this rehabilitation protocol is ideal. Animal studies have shown that longer periods of immobilization are beneficial to healing after rotator cuff repair.
A recent study published in The Journal of Bone and Joint Surgery investigated the effectiveness of immobilization after surgery in human subjects. The goal was to determine if longer periods of immobilization resulted in any clinical differences in outcomes, including shoulder range of motion, retear rates and clinical outcome scores. One hundred participants who met specific criteria and underwent arthroscopic repair of the rotator cuff were randomly sorted into two groups. One group was immobilized after surgery for four weeks, the other was immobilized for eight weeks. After the allotted time of immobilization each participant underwent rehabilitation with a physical therapist that included passive range of motion then progressed to active range of motion and strengthening.
At follow up conducted at six months and 24 months after surgery, there were no statistical differences between the groups with retear rates, passive range of motion or clinical scores. There were more reports of stiffness by participants who were immobilized for eight weeks compared to those immobilized for 4 weeks. Patients were also less likely to adhere to the immobilization guidelines for a full eight weeks compared to those immobilized for four weeks. With no benefit in healing or diminished retear rate gained by immobilization for eight weeks, it is deemed most beneficial to promote immobilization for four weeks after rotator cuff repair. The retear rate in this study was 10 per cent, compared to previously reported rates of 20 per cent to 40 per cent in studies that involved early passive range of motion before four weeks. Thus a four week immobilization period may give the rotator cuff ample time to heal without increased stiffness and decrease retear rates.
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References:
Kyoung Hwan Koh, MD et al. Effect of Immobilization without Passive Exercise After Rotator Cuff Repair. In The Journal of Bone and Joint Surgery. March 2014. Vol. 96A. No. 6. Pp. E44 1-9.
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