A Comparison of Rehabilitation Methods After Arthroscopic Rotator Cuff Repair

Abstract

Context:Despite the significant attention directed toward optimizing arthroscopic rotator cuff repair, there has been less focus on rehabilitation after rotator cuff repair surgery.Objective:To determine the effect of different rehabilitation protocols on clinical outcomes by comparing early versus late mobilization approaches and continuous passive mobilization (CPM) versus manual therapy after arthroscopic rotator cuff repair.Data Sources:PubMed was searched for relevant articles using the keywords rotator cuff, rotator, cuff, tears, lacerations, and rehabilitation to identify articles published from January 1980 to March 2014.Study Selection:Inclusion criteria consisted of articles of level 1 or 2 evidence, written in the English language, and with reported outcomes for early versus late mobilization or rehabilitation with CPM versus manual therapy after primary arthroscopic rotator cuff repair. Exclusion criteria consisted of articles of level 3, 4, or 5 evidence, non-English language, and those with significantly different demographic variables between study groups. Included studies were evaluated with the Consolidated Standards of Reporting Trials criteria.Study Design:Systematic review.Level of Evidence:Level 2.Data Extraction:Level of evidence, study type, number of patients enrolled, number of patients at final follow-up, length of follow-up, age, sex, rotator cuff tear size, surgical technique, and concomitant operative procedures were extracted from included articles. Postoperative data included clinical outcome scores, visual analog score for pain, shoulder range of motion, strength, and rotator cuff retear rates.Results:A total of 7 studies met all criteria and were included in the final analysis. Five studies compared early and late mobilization. Two studies compared CPM and manual therapy.Conclusion:In general, current data do not definitively demonstrate a significant difference between postoperative rotator cuff rehabilitation protocols that stress different timing of mobilization and use of CPM.

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

“…Two other systematic reviews also cited no statistically significant differences in PROs for continuous passive motion versus manual therapy. 79,245 Thomson et al 229 systematically reviewed 11 studies and discovered improved postoperative PROs overall but did not find any single rehabilitation program to be superior to another. Marik and Roll 128 indicated (1) strong evidence to support postoperative rehabilitation involving progressive tendon forces plus standard rehabilitation and (2) inconclusive evidence regarding other types of postoperative rehabilitation (ie, continuous passive motion, supervised vs unsupervised therapy, and land-based vs aquatic-based therapy).…”

“…Four meta-analyses and 1 systematic review documented no statistically significant differences in functional outcomes, ROM, and retear rates for early versus delayed rehabilitation. 28,29,115,131,245 A few meta-analyses found some evidence for better ER 30,56,207 and forward elevation 56,179 for early ROM but better function 30,56 and healing 30 for delayed ROM. When making comparisons with delayed passive ROM (3-6 weeks after surgery), Kluczynski et al 98 discovered (1) fewer retears for early passive ROM (within 1 week of surgery) for tears ≤3 cm repaired by transosseous or SR methods and (2) increased retears for early passive ROM for tears >5 cm repaired by DR or any other method.…”

Effectiveness of early compared with conservative rehabilitation for patients having rotator cuff repair surgery: an overview of systematic reviews

“…The R-AMSTAR values ranged from 20 for Yi et al 22 to 38 for Chan et al 16 and Chang et al ,18 of a possible total of 44; the individual scores are described in table 1. The item with lowest scores was 10, which considered publication bias and the use of statistical tests such as Egger regression to address this issue; only the studies by Chang et al 18 and Chen et al 23 fulfilled these criteria.…”

Cut-off values of the Japanese Orthopaedic Association score corresponding to Constant scores for evaluating outcomes in rotator cuff tear

“…The Constant score is one of the shoulder joint assessment methods that are used internationally to evaluate the outcome of rotator cuff tear. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] A Constant score of !80 is regarded to indicate satisfactory outcome. 20 Fuchs et al 33 reported the outcomes of rotator cuff tear treated via open repair with suture fixation; the mean pre-operative Constant score of patients with supraspinatus muscle tear was 54.3, which improved to 80.5 at 38 months post-operatively; however, in patients with subscapularis tear, the score improved from 51.8 to 72.9 and two patients with musculotendinous tear did not achieve a satisfactory score.…”