Special thanks to star physical therapist Leah Versteegen for providing this write up on a recent article from The Journal of Bone and Joint Surgery.
Shoulder rotator cuff repair aims to suture torn rotator cuff tendons and provide them with the optimal environment to heal and minimize chance of retear. Overall retear rates have decreased over the years, but are still a major concern. Better suture techniques have been thoroughly investigated but there is less attention paid to the rehabilitation protocol. Currently the gold standard for rehabilitation after surgery is to wear an abduction brace and begin physical therapy for passive range of motion within the first few weeks.
As surgical techniques have evolved from open surgery to arthroscopic surgery, there are questions as to whether this rehabilitation protocol is ideal. Animal studies have shown that longer periods of immobilization are beneficial to healing after rotator cuff repair.
A recent study published in The Journal of Bone and Joint Surgery investigated the effectiveness of immobilization after surgery in human subjects. The goal was to determine if longer periods of immobilization resulted in any clinical differences in outcomes, including shoulder range of motion, retear rates and clinical outcome scores. One hundred participants who met specific criteria and underwent arthroscopic repair of the rotator cuff were randomly sorted into two groups. One group was immobilized after surgery for 4 weeks, the other was immobilized for 8 weeks. After the allotted time of immobilization each participant underwent rehabilitation with a physical therapist that included passive range of motion then progressed to active range of motion and strengthening.
At the follow up conducted at 6 months and 24 months after surgery, there were no statistical differences between the groups with retear rates, passive range of motion or clinical scores. There were more reports of stiffness by participants who were immobilized for 8 weeks compared to those immobilized for 4 weeks. Patients were also less likely to adhere to the immobilization guidelines for a full 8 weeks compared to those immobilized for 4 weeks.
With no benefit in healing or diminished retear rate gained by immobilization for 8 weeks, it is deemed most beneficial to promote immobilization for 4 weeks after rotator cuff repair. The retear rate in this study was 10%, compared to previously reported rates of 20%-40% in studies that involved early passive range of motion before 4 weeks Thus a 4 week immobilization period may give the rotator cuff ample time to heal without increased stiffness and decrease retear rates.
Kyoung Hwan Koh, MD et al. Effect of Immobilization without Passive Exercise After Rotator Cuff Repair. In The Journal of Bone and Joint Surgery. March 2014. Vol. 96A. No. 6. PpE44 1-9.