10/11/2015

RehabilitationFollowingArthroscopicRotatorCuffRepair|TheJournalofBone&JointSurgery

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RehabilitationFollowingArthroscopicRotatorCuffRepair
AProspectiveRandomizedTrialofImmobilizationComparedwithEarlyMotion
JayD.Keener,MDLeesaM.Galatz,MDGeorgiaStobbsCucchi,RNRebeccaPatton,MAKenYamaguchi,MD
JBoneJointSurgAm,2014Jan0196(1):1119.http://dx.doi.org/10.2106/JBJS.M.00034

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ll Abstract
Background:Theinfluenceofrehabilitationontheoutcomesafterarthroscopicrotatorcuffrepair
remainsunknown.Thepurposeofthisstudywastocompareclinicalresultsandtendonhealingrates
followingarthroscopicrotatorcuffrepairutilizingtwodistinctrehabilitationprotocols.
Methods:Overathirtymonthperiod,124patientsundertheageofsixtyfiveyearsunderwent
arthroscopicrepairofafullthicknessrotatorcufftearmeasuring<30mminwidth.Postoperatively,

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patientswererandomizedeithertoatraditionalrehabilitationprogramwithearlyrangeofmotionorto
animmobilizationgroupwithdelayedrangeofmotionforsixweeks.Clinicaloutcomesassessment
includedvisualanalogpainscalescore,AmericanShoulderandElbowSurgeons(ASES)score,Simple
ShoulderTest(SST),relativeConstantscore,andstrengthmeasurementsatsix,twelve,andtwenty
fourmonths.Tendonintegritywasassessedwithultrasonographyataminimumoftwelvemonths
postoperatively.
Results:Therewerenosignificantdifferencesinpatientage,tearsize,ormeasuresofpreoperative
functionbetweengroupsatbaseline.Finalclinicalfollowupwasavailablefor114subjects(92%).
Activeelevationandexternalrotationwerebetterinthetraditionalrehabilitationgroupatthreemonths.
Nosignificantdifferenceswereseeninfunctionalscores,activemotion,andshoulderstrengthbetween
rehabilitationgroupsatlatertimepoints.Functionaloutcomesplateauedatsixortwelvemonthsexcept
fortherelativeConstantscore,whichimproveduptotwentyfourmonthsfollowingsurgery.Ninetytwo
percentofthetearswerehealed,withnodifferencebetweenrehabilitationprotocols(p=0.46).
Conclusions:Arthroscopicrepairofsmallandmediumfullthicknessrotatorcufftearsresultsin
reliableimprovementsinclinicaloutcomesandahighrateoftendonintegrityusingadoublerowrepair
techniqueinpatientsundertheageofsixtyfiveyears.Thereisnoapparentadvantageor
disadvantageofearlypassiverangeofmotioncomparedwithimmobilizationwithregardtohealingor
functionaloutcome.
LevelofEvidence:TherapeuticLevelI.SeeInstructionsforAuthorsforacompletedescriptionof
levelsofevidence.
ll Footnotes
AcommentarybyStephenF.Brockmeier,MD,islinkedtotheonlineversionofthisarticleat
jbjs.org.
InvestigationperformedattheShoulderandElbowService,DepartmentofOrthopaedicSurgery,
WashingtonUniversity,St.Louis,Missouri
PeerReview:ThisarticlewasreviewedbytheEditorinChiefandoneDeputyEditor,andit
underwentblindedreviewbytwoormoreoutsideexperts.Itwasalsoreviewedbyanexpertin
methodologyandstatistics.TheDeputyEditorreviewedeachrevisionofthearticle,andit
underwentafinalreviewbytheEditorinChiefpriortopublication.Finalcorrectionsand
clarificationsoccurredduringoneormoreexchangesbetweentheauthor(s)andcopyeditors.
Disclosure:Oneormoreoftheauthorsreceivedpaymentsorservices,eitherdirectlyor
indirectly(i.e.,viahisorherinstitution),fromathirdpartyinsupportofanaspectofthiswork.In
addition,oneormoreoftheauthors,orhisorherinstitution,hashadafinancialrelationship,in
thethirtysixmonthspriortosubmissionofthiswork,withanentityinthebiomedicalarenathat
couldbeperceivedtoinfluenceorhavethepotentialtoinfluencewhatiswritteninthiswork.No
authorhashadanyotherrelationships,orhasengagedinanyotheractivities,thatcouldbe
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RehabilitationFollowingArthroscopicRotatorCuffRepair|TheJournalofBone&JointSurgery

perceivedtoinfluenceorhavethepotentialtoinfluencewhatiswritteninthiswork.Thecomplete
DisclosuresofPotentialConflictsofInterestsubmittedbyauthorsarealwaysprovidedwith
theonlineversionofthearticle.
Copyright2014byTheJournalofBoneandJointSurgery,Incorporated
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RehabilitationFollowingArthroscopicRotatorCuffRepair|TheJournalofBone&JointSurgery

Needham,MA02492USA
OnlineISSN:15351386
Copyright2015.AllRightsReserved
TheJournalofBoneandJointSurgery,Inc.

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