Patients Who Undergo Rotator Cuff Repair Can Safely Return to Driving at 2 Weeks Postoperatively

Abstract

Background:Evidence-based guidelines are lacking for return to driving following rotator cuff repair (RCR). As a result, surgeons are often overly conservative in their recommendations, placing potential undue burden on patients and their families. Therefore, the primary objective of this study was to formulate evidence-based return-to-driving guidelines.Methods:Thirty-two subjects planning to undergo primary RCR were enrolled. Driving fitness was assessed in a naturalistic setting with an instrumented vehicle on public streets with a safety monitor onboard. Driving kinematic measures and behavioral data were obtained from vehicle data and camera capture. Several driving tasks and maneuvers were evaluated, including parking, left and right turns, straightaways, yielding, highway merges, and U-turns. The total course length was 15 miles (24 km) and the course took 45 to 55 minutes to complete. The subjects’ baseline drive was performed prior to RCR and postoperative drives occurred at 2, 4, 6, and 12 weeks after RCR. All drives consisted of identical routes, tasks, and maneuvers. Driving metrics were analyzed for differences between baseline and postoperative drives, including differences in gravitational force equivalents (g).Results:Twenty-seven subjects (mean age, 58.6 years [range, 43 to 68 years]) completed all 5 drives. Of the 13 analyzed kinematic metrics measured from 14 of 17 driving events, all exhibited noninferiority across all postoperative drives (2 to 12 weeks) after RCR compared with baseline. Beginning at postoperative week 2, subjects generally braked less aggressively, steered more smoothly, and drove more stably. Kinematic metrics during the performance of specific maneuver types also showed noninferiority when compared with baseline. Of note, subjects drove more smoothly on highway merges starting at postoperative week 2 (minimum longitudinal acceleration, −0.35 g [95% confidence interval (CI), −0.050 to −0.019 g]; standard deviation of longitudinal acceleration, 0.008 g [95% CI, 0.003 to 0.013 g]), but exhibited more aggressive driving and acceleration on highway merges at postoperative week 12 (maximum absolute yaw, −0.8°/sec [95% CI, −1.2°/sec to −0.4°/sec]).Conclusions:Patients showed no clinically important negative impact on driving fitness as early as 2 weeks after RCR. Adaptive behaviors were present both preoperatively and postoperatively.Level of Evidence:Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Return to driving post upper or lower extremity orthopaedic surgical procedures: a scoping review of current published literature

“…( 60 ), Hasan et al . ( 62 ), Badger et al ( 63 ), McClelland et al . ( 64 ), Newington et al ( 65 ), Hammert et al ( 66 ), Acharya et al .…”

“…In total, 68 studies were identified meeting our study aims and inclusion criteria for both upper and lower extremity procedures ( Fig. 1 , Table 1 , Supplementary Tables 1 and 2) ( 1 , 14 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ). There was a wide variation in procedures performed and sample size, the study methodology, and measurements obtained.…”

“…There were 37 studies included for upper extremity procedures and guidelines ( 1 , 4 , 14 , 42 , 43 , 49 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ). Some studies reported dominant versus non-dominant limb, while others reported handedness.…”

“…Two articles assessed rotator cuff repair: one using a driving simulator and the other a road driving assessment ( 62 , 63 ). The parameters assessed were driving performance as specified by such measures as number of collisions, centre-line crossings, and off-road excursions.…”

Shoulder & Elbow

“…Many surgeons guess or estimate a duration, but laudably a team from Roanoke (Virginia, USA) have attempted to objectively answer the question and develop evidence-based guidelines. 4 In their study, 32 patients undergoing a primary repair of the rotator cuff were studied prospectively, and driving fitness was assessed in a naturalistic setting in an instrumented vehicle on public roads with safety monitoring on board. Specific driving tasks and manoeuvres were monitored and evaluated, including turning, parking, and U-turns.…”