A Review of Online Rehabilitation Protocols Designated for Rotator Cuff Repairs

Abstract

Purpose: To compare publicly available rehabilitation protocols designated for rotator cuff (RTC) repairs published online by academic residency programs and private practice institutions. Methods: A systematic electronic search using the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) was performed for RTC repair rehabilitation protocols. Private practice programs with published rehabilitation protocols that were discovered during the Google search were also included for review, but no comprehensive search for private practice protocols was performed. The main exclusion criteria consisted of noneEnglish-language protocols and protocols without any of the time-based components in question. Included protocols were assessed independently based on the specified RTC tear size (small [1 cm], medium [1-4 cm], large or massive [5 cm], or no mention of size). Protocols were compared based on the inclusion, exclusion, and timing of certain rehabilitation components. Results: A total of 96 rehabilitation protocols were included for review, from 39 academic institutions and 28 private practice programs. Specific instructions for concomitant biceps tenodesis were included in 26 protocols (27.1%). Of the 96 protocols, 88 (91.7%) did not place restrictions on early postoperative passive range of motion (PROM) of the shoulder. Isolated PROM with restrictions on active range of motion was most commonly recommended for the first 4 or 6 weeks postoperatively (80.2%). Use of a sling or immobilizer was most frequently recommended for the first 4 or 6 weeks postoperatively (78.1%). Wide variation was noted in recommendations for returning to resistance strengthening, with the highest incidence being 27 protocols recommending returning at 12 weeks (28.1%); this further varied based on the size of the tear. A total of 21 protocols (21.9%) recommended the use of cryotherapy postoperatively. Conclusions: Although certain rehabilitation components were common, such as duration of PROM and sling or immobilizer use, a large degree of variation remains among published rehabilitation protocols after RTC repair, and this variability is still seen even when subdividing by the size or severity of the RTC tear. Clinical Relevance: Rehabilitation after RTC repair is crucial to patient outcomes. This study summarizes the variability among online rehabilitation protocols for RTC repair in the United States and emphasizes the importance of appropriate rehabilitation after RTC surgery.

Rehabilitation following rotator cuff repair: A survey of current practice (2020)

“…Hence, despite surgical progress in terms of less invasive operations and stronger implants resulting in more secure repairs (Funk, 2012), in tandem with evidence raising questions about current approaches to rehabilitation including the need for, or value of immobilisation, rehabilitation practice of most respondents does not seem to have evolved. The recommendation to immobilise following rotator cuff repair and to introduce passive movement during this time has been reflected in other international surveys (Coda et al, 2020; Kane et al, 2020).…”

“…Following this surgery, patients undergo a programme of rehabilitation, usually supported by a physiotherapist, with the aim of restoring movement, strength and supporting a return to usual activities of daily living, including work and leisure (Littlewood & Bateman, 2015). Effective rehabilitation is important to help patients achieve the best clinical and quality of life outcomes (Coda et al, 2020; Kane et al, 2020).…”

Alle Muskeln machen mit – Physiotherapie nach Rotatorenmanschetten-Rekonstruktion

“…Die Nachbehandlung nach einer RMS-Rekonstruktion ist analog zu vielen anderen muskuloskelettalen Beschwerden nicht einheitlich geregelt. Dies zeigen beispielsweise die Arbeiten von Galetta et al 15 und Coda et al 7 . In 51 bzw.…”

Current concepts in the rehabilitation of rotator cuff related disorders

“…Expert consensus regarding post-operative rehabilitation is limited by a lack of high-quality studies 64 and wide variation currently exists between individual surgeon's post-operative protocols. 65 Concerns regarding the failure of surgical repairs drive the debate around protection and immobilisation versus early mobilisation and controlled load, preventing stiffness and further deconditioning of the soft tissues. Slings are used to protect the healing tissues but reported side effects including impaired gait and increased risk of falls and patient frustration due to delayed function and return to work.…”