Abstract
Background
Evidence on the ideal rehabilitation program for arthroscopic rotator cuff repair is lacking. Most data and results are conflicting with no consensus made. This study aims to compare between an early aggressive program with immediate postoperative range-of-motion (ROM) exercises and a more conservative program with early restriction of motion in Hong Kong Chinese population.
Materials and Methods
We retrospectively evaluated 37 arthroscopic rotator cuff repair cases who underwent a standardized delayed rehabilitation protocol of immobilization for 4 weeks to 6 weeks before formal passive ROM exercises. Patients were evaluated at 3 months, 6 months, and 12 months after the surgery, for which they would be tested on passive forward flexion (FF). They were categorized as “stiff if FF was less than 100°. Constant score, Disability of Arm, Shoulder and Hand (DASH) score, Visual Analog Scale (VAS) score, and isometric abduction power deficit percentage were parameters to assess the functional outcome, and they were obtained in all of the patients’ last follow-up assessments.
Results
Two cases (5.4%) are considered “stiff 6 months after the surgery. At 1 year, the stiffness in both cases resolved, resulting in 0% rate of stiffness. The mean FF at 1 year was 153.33 ± 20.15, which is comparable to the literature. Two cases (5.4%) of clinical retear occurred. Mean Constant score at the latest follow-up was 62.4 ± 13.2. Mean VAS score was 1.1 ± 1.8 at rest and 2.8 ± 2.0 on exertion. Mean DASH score was 25.3 ± 21.9. Mean isometric abduction power deficit was 42.7% ± 0.2%.
Discussion
Historically, due to concerns on long-term stiffness, an early aggressive postoperative rehabilitation protocol was used. We found that an early restriction of ROM with 4 weeks to 6 weeks of immobilization did not lead to long-term stiffness and functional disadvantage. This includes patients with stiffness even before the operations.
Conclusions
Immobilization for 4 weeks to 6 weeks after arthroscopic rotator cuff repair does not result in long-term stiffness and may even be beneficial to cuff tendon healing.