It is always wonderful to have Level I studies in orthopaedics; congratulations to the authors. This study includes 68 patients with average age of 63 with isolated supraspinatus tears repaired arthroscopically ('transosseous equivalent'). The patients were randomized to either a rehabilitation program that included early passive elevation by a therapist three times a week with home pendulum exercises starting on postop day 2 or a delayed group that had no formal PT for 6 weeks, but did do pendulum exercises for the first six weeks.
The SST scores for the early motion group improved from 5.5 to 11.1 while the scores for the delayed group improved from 5.1 to 11.1. The authors used a value of 2 for the minimal clinically important difference for the SST.
By ultrasound, 8 (12%) of the shoulders had recurrent tears at an average of 12.2 months after surgery with no significance difference between the two different rehab groups. This is consistent with the results previously reported by Harryman et al at 5 years after repair. Interestingly, three patients were unsatisfied with their result, one of which had an intact repair by ultrasound. The six patients other patients with recurrent tears had satisfactory outcomes with an improvement of the SST from 5.2 to 11.1 (the same as the result of the intact repairs.
So, again we see that (1) even for relatively small (one tendon) tears, one in eight repairs were not intact at a year, (2) patients with recurrent tears can achieve the same level of self-assessed comfort and function as those with intact repairs, and (3) an intact repair does not necessarily mean that the comfort and function of the shoulder is restored.
With respect to the rehab, this study does not seem to provide justification for the expense of formal physical therapy in the first six weeks after cuff repair.
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