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