Rehabilitation of Arthroscopic Rotator Cuff Repair: Accelerated Protocol
DÜZGÜN İ, BALTACI G. Hacettepe University School of Physiotherapy & Rehabilitation 06100 Ankara-TURKEY

Purpose: Rotator cuff tear is a common shoulder problem in both young and adults. It is classified into partial-thickness tears according to the depth of the lesion and the anatomic site. Rehabilitation of the shoulder following a rotator cuff repair is variable and is dependent not only on the quality of the repair, but also on the tear size and extent of medial retraction. Literature suggests that the rehabilitation program is aproximately 6-8 weeks are required for tendon to bone healing that will allow for active motion of the shoulder after rotator cuff repair. The accelerated rehabilitation programs have resulted in an earlier restoration of motion, strength, and function without comprimising stability. Strict immobilisation has been shown to be responsible for the development of functional instability in the shoulder secondary to rotator cuff inhibition, muscular atrophy, and poor neuromuscular control. The aim of this study was to compare the effects on pain and functional status between slow and accelerated rehabilitation protocols.

Subjects: The study included 15 patients (age = 59±9 years) who had undergone to rotator cuff repair in between 2002 and 2006. Including criterias were determined to Type II and Type III rotator cuff tear, no neurologic deficits. 6 patients were managed with slow protocol including the active range of motion at 6 weeks after surgery and 9 patients with accelerated protocol including the manual therapy after 1 week from surgery and allowed to active range of motion after 3 weeks from surgery. Although slow protocol was completed for 24 weeks the accelerated protocol completed for 8 weeks. All patients were evaluated to pre and post-treatment with functional status and pain. Pain was determined with visual analog scale during rest, activity, and night. Constant score was used to determine the functional level. Mann Whitney U test was used for compare to protocols and the Paired samples T-test for evaluate the differences between pre and post-treatment scores.

Results: There were no significant differences between patients’ age in that slow (56.8±8.5 years) and accelerated protocols (60.4±9.8 years). Rest pain at pre-rehabilitation was found significant differences between groups (slow=4.8±3.9, accelerated=1.1±1.7). On the other hand activity pain, night pain, constant score of pre and post-treatment and rest pain at post-rehabilitation were no signifiant differences between groups (p>0.05). When comparing pre to post-rehabilitation for activity pain and constant score all patients were seen significant improved  though at rest and night pain were found no significant differences (p>0.05).

Conclusion: The risk during rehabilitation both negative effects of immobilisation and return to daily living activity earlier have been decreased with the accelerated protocol. Satisfactory results of the patients need to show with long-term follow-up.

Clinical Relevance: The accelerated rehabilitation might be recommended for physical therapists.