Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol
Authors: Cuff & Pupello
References: Journal of Shoulder and Elbow Surgery Volume 21, Issue 11 , Pages 1450-1455, November 2012
This study evaluated patient outcomes and rotator cuff healing after arthroscopic rotator cuff repair using a postoperative physical therapy protocol with early passive motion compared with a delayed protocol that limited early passive motion.
Materials and methods
The study enrolled 68 patients (average age, 63.2 years) who met inclusion criteria. All patients had a full-thickness crescent-shaped tear of the supraspinatus that was repaired using a transosseous equivalent suture-bridge technique along with subacromial decompression. In the early group, 33 patients were randomized to passive elevation and rotation that began at postoperative day 2. In the delayed group, 35 patients began the same protocol at 6 weeks. Patients were monitored clinically for a minimum of 12 months, and rotator cuff healing was assessed using ultrasound imaging.
Both groups had similar improvements in preoperative to postoperative American Shoulder and Elbow Surgeons scores (early group: 43.9 to 91.9, P < .0001; delayed group: 41.0 to 92.8, P < .0001) and Simple Shoulder Test scores (early group: 5.5 to 11.1, P < .0001; delayed group: 5.1 to 11.1, P < .0001).
There were no significant differences in patient satisfaction, rotator cuff healing, or range of motion between the early and delayed groups.
Patients in the early group and delayed group both demonstrated very similar outcomes and range of motion at 1 year. There was a slightly higher rotator cuff healing rate in the delayed passive range of motion group compared with the early passive range of motion group (91% vs 85%).
Comments & Critique:
- The 'immobilisation' group were not immobilised (performed pendular exercises from Day 0)
- There was no difference in results after 6 months, but no data reported for < 6months - ? time to return to work and sports, pain relief in the early to mid recovery phases.
- My conclusion is that it is safe to start early passive motion before 3 weeks, as the long term results are the same; plus there may be short-term benefits