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Scientific Articles   |    
Rehabilitation Following Arthroscopic Rotator Cuff RepairA Prospective Randomized Trial of Immobilization Compared with Early Motion
Jay D. Keener, MD1; Leesa M. Galatz, MD1; Georgia Stobbs-Cucchi, RN1; Rebecca Patton, MA1; Ken Yamaguchi, MD1
1 Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, CB #8233, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu
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  • Disclosure statement for author(s): PDF

A commentary by Stephen F. Brockmeier, MD, is linked to the online version of this article at jbjs.org.

Investigation performed at the Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2014 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2014 Jan 01;96(1):11-19. doi: 10.2106/JBJS.M.00034
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Abstract

Background: 

The influence of rehabilitation on the outcomes after arthroscopic rotator cuff repair remains unknown. The purpose of this study was to compare clinical results and tendon healing rates following arthroscopic rotator cuff repair utilizing two distinct rehabilitation protocols.

Methods: 

Over a thirty-month period, 124 patients under the age of sixty-five years underwent arthroscopic repair of a full-thickness rotator cuff tear measuring <30 mm in width. Postoperatively, patients were randomized either to a traditional rehabilitation program with early range of motion or to an immobilization group with delayed range of motion for six weeks. Clinical outcomes assessment included visual analog pain scale score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), relative Constant score, and strength measurements at six, twelve, and twenty-four months. Tendon integrity was assessed with ultrasonography at a minimum of twelve months postoperatively.

Results: 

There were no significant differences in patient age, tear size, or measures of preoperative function between groups at baseline. Final clinical follow-up was available for 114 subjects (92%). Active elevation and external rotation were better in the traditional rehabilitation group at three months. No significant differences were seen in functional scores, active motion, and shoulder strength between rehabilitation groups at later time points. Functional outcomes plateaued at six or twelve months except for the relative Constant score, which improved up to twenty-four months following surgery. Ninety-two percent of the tears were healed, with no difference between rehabilitation protocols (p = 0.46).

Conclusions: 

Arthroscopic repair of small and medium full-thickness rotator cuff tears results in reliable improvements in clinical outcomes and a high rate of tendon integrity using a double-row repair technique in patients under the age of sixty-five years. There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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