Factors Affecting Postoperative Rehabilitation Therapy Utilization After Arthroscopic Rotator Cuff Repair: An Epidemiological Analysis

Abstract

Background and objectiveRotator cuff tear (RCT) is an orthopedic shoulder pathology commonly managed via arthroscopic rotator cuff repair (ARCR) after the failure of conservative treatment options. Physical therapy (PT) after ARCR is an important component of patient recovery. Postoperative complications, such as postoperative shoulder stiffness (POSS), are frequent among these patients and place a significant burden on patients and clinicians. The purpose of this study is to analyze temporal PT utilization among patients after ARCR and its potential to improve patient outcomes and examine possible factors affecting postoperative complication rates. MethodsAn epidemiological study was performed by using a large de-identified national health research network (TriNetX) within the United States to search for patients with a diagnosis of partial or complete RCT and subsequent ARCR. Data were collected on patient demographics, number of postoperative PT visits, and PT visits distribution in the early postoperative period. Statistical analysis was performed to analyze factors that impacted the utilization of postoperative PT after ARCR. ResultsA total of 21,540 patients underwent ARCR with 11,312 receiving ARCR for partial RCT and 10,228 for complete RCT. Of all ARCR patients, 6,923 (32.1%) received postoperative PT within one year of ARCR. Patients with partial RCT had a greater number of PT visits (mean ±SD: 3.85 ± 8.33; min-max: 0-110; t = 15.2) compared to patients with complete RCT (2.90 ± 7.97; min-max: 0-125) after ARCR (p<0.001). Patients with ARCR for partial RCT also had more visits within the first 12 weeks after ARCR as compared to patients with ARCR for complete RCT (p<0.001). Female patients had more visits than male patients after ARCR, regardless of the RCT extent (p<0.001). ConclusionPartial RCT and female sex are associated with increased postoperative PT usage after ARCR. Postoperative PT utilization has high variability after ARCR, regardless of the RCT extent. More research is needed to further explore the impact of PT utilization on postoperative complications after ARCR.

The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review

“…Diabetes mellitus and increased time until rehabilitation after ARCR have been reported as independent risk factors for POSS in the literature [6]. Recently, the relationship between rehabilitation usage after ARCR and tear type has been investigated with ARCR for partial-thickness rotator cuff tears being associated with increased postoperative physical therapy [30]. One possible reason for this association could be the increased incidence of POSS in patients with ARCR for partial-thickness tears as indicated by the current study.…”