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

Abstract

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)

Effect of Smoking on Healing Failure After Rotator Cuff Repair

“…Consequently, arthroscopic rotator cuff repair, a widely accepted treatment for full-thickness rotator cuff tears, is being performed with increasing frequency. 8,37,40 However, despite surgical improvement, the healing failure rate after rotator cuff repair is considerably high (20%-94%). 24,40 Thus, many studies have attempted to identify factors related to healing failure after rotator cuff repair, and several patient-related risk factors have been identified, such as age, preoperative tear size, fatty infiltration, osteoporosis, and tendon quality.…”

Arthroscopic Repair of Partial-Thickness and Small Full-Thickness Rotator Cuff Tears

“…Rotator cuff tears frequently cause shoulder pain and dysfunction, 10,36 and symptom relief may be expected by anatomic healing of the torn rotator cuffs through surgical repair. 2,36,43 Rotator cuff tears can be classified as partial-thickness and full-thickness rotator cuff tears. Partial-thickness tears are reported to be approximately twice as common as full-thickness tears, 49 with a reported prevalence of 6% to 39%, 6,21,35 and they are frequently symptomatic and may increase in size or progress to fullthickness tears if left untreated.…”

Short-term Comparison of Supervised Rehabilitation and Home-based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair

“…Immobilization for a certain period and proper rehabilitation are important factors for successful clinical results in rotator cuff repair surgery. However, a longer period of immobilization might lead to higher prevalence of stiffness, despite a lower possibility of retear [ 16 ]. It was reported that the prevalence of shoulder stiffness after an arthroscopic rotator cuff repair was usually 10%, and the resistant postoperative stiffness (which is permanent or needs capsular release) was 3.3% to 4.5% [ 17 ].…”