Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?

Kim, Yang-Soo; Chung, Seok Won; Kim, Joon Yub; Ok, Ji-Hoon; Park, In; Oh, Joo Han

doi:10.1177/0363546511434287

Cited by 176 publications

(160 citation statements)

References 19 publications

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“…They found no difference, however, in longterm functional outcomes between the two groups [62] . In contrast, Kim et al [61] evaluated early and delayed range of motion protocols after rotator cuff repair and found no statistically significant difference in healing rates between the two groups with a trend toward lower re-tear rates in the early range of motion group (12% vs 18%).…”

Section: Rehabilitationmentioning

confidence: 95%

“…Data are conflicting on which, if any, of these programs provides superior results. Early aggressive rehabilitation programs have been shown to result in better early outcomes, pain relief, and range of motion however most studies show no difference with regard to these parameters with longer-term followup [60][61][62][63][64][65][66] . One concern with early aggressive rehabilitation programs is that they may be associated with a higher incidence of tendon re-tear.…”

Section: Rehabilitationmentioning

confidence: 99%

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Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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Section: Rehabilitationmentioning

confidence: 95%

Section: Rehabilitationmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

162

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“…Rehabilitation following surgical repair can involve significant periods of time, with some protocols providing guidance to therapists for 4 to 6 months, but this can be extended by complications such as tendon non-healing, which varies from 12% to 94% (Boileau et al, 2005;Galatz, Ball, Teefey, Middleton, & Yamaguchi, 2004;Kim et al, 2012;Thigpen et al, 2016). Tendon healing can be affected by various surgical, mechanical and patient specific factors following surgical repair (Mall, Tanaka, Choi, & Paletta, 2014).…”

Section: Introductionmentioning

confidence: 99%

Rotator cuff repair protocols: A survey of current New Zealand practice

Harman¹,

Olds²

2017

NZJP

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Rehabilitation following surgical rotator cuff repair may enable return to pre-injury function. Optimal recovery is facilitated by the use of post-operative protocols that enhance communication between the surgeon and physiotherapist. The purpose of this study was to describe the rotator cuff repair rehabilitation protocols currently used in New Zealand. Orthopaedic surgeons practising in New Zealand were contacted to determine their current rehabilitation protocols. Length of immobilisation and exercise progression following surgical repair were analysed across weekly timeframes from the day of surgery until nine months post-operatively. The response rate was 55% with protocols received from 31 surgeons. Post-surgical rotator cuff protocols currently in use in New Zealand are predominantly determined by weekly time periods which vary from surgeon to surgeon. Immobilisation was most commonly recommended for four to six weeks, pendular exercises were started the week of surgery, active exercises commenced at six weeks, followed by resisted exercises at twelve weeks. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. Level of detail regarding sets and repetitions of exercises also differed between protocols. Variability across protocols was evident regarding the recommended activity level and time period from surgery. Consideration of tissue quality, size of the tear and strength of the repair is recommended to facilitate optimal results.

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“…In contrast to our study, they reported no differences between the different starting periods on the rate of retear or on the range of motion. However, it is important to note that we have excluded, unlike Kim et al, 30) small-sized tears because the rate of retear is generally low in this category. Thus, our study of the repair of rotator cuffs with medium-size or above tears, indicates that delayed passive exercise may reduce the rate of retear.…”

Section: Discussionmentioning

confidence: 96%

“…In fact, Brislin et al 16) reports a rate of stiffness at 8.6% (23 out of 268 patients) after the arthroscopic repair of the rotator cuff. In a study of a similar context, Kim et al 30) investigated the starting period of passive exercise in the repair of rotator cuffs with small-and mediumsized tears. In contrast to our study, they reported no differences between the different starting periods on the rate of retear or on the range of motion.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Different Starting Periods of Passive Exercise on the Clinical Outcome of Arthroscopic Rotator Cuff Repair

Back¹,

Tae²,

Kim³

et al. 2014

Clin Shoulder Elbow

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Background: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff. Methods: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than 90˚ were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than 30˚ compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria. Results: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up. Conclusions: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness. (Clin Shoulder Elb 2014;17(2):57-63)

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Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?

Cited by 176 publications

References 19 publications

Factors affecting healing after arthroscopic rotator cuff repair

Factors affecting healing after arthroscopic rotator cuff repair

Rotator cuff repair protocols: A survey of current New Zealand practice

The Effect of Different Starting Periods of Passive Exercise on the Clinical Outcome of Arthroscopic Rotator Cuff Repair

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