Friday, July 24, 2015

Rotator cuff repairs - how should they be rehabilitated?

Efficacy of informed versus uninformed physiotherapy on postoperative retear rates of medium-sized and large rotator cuff tears

Concerned about the risk of retear, these authors compared early postoperative rehabilitation with a
limitable pendulum exercise device combined with informed physiotherapy to a standardized protocol of rehabilitation performed at home. In the informed PT group, a therapist used computer imagery to observe whether vertical acceleration was over a given threshold (identified as physiologic tremors), as a warning of and precaution associated with the increased risk of repair failure.

They enrolled 24 patients who were evaluated using clinical outcomes and magnetic resonance images preoperatively and 12 weeks after surgery.

While similar self-reported functional outcomes were reported for the two groups, the rate of recurrent tears was significantly higher for both the medium sized and large areas in the uninformed home rehabilitation group compared with the informed group. Six of 15 repairs of small to medium tears failed while 6 of 9 repairs of large tears failed.

Comment: The real story here is that out of 24 rotator cuff repair surgeries, 12 (50%) had anatomic failure by MRI and, as we've seen over and over, the clinical result did not correlate with the repair integrity.

The challenge in determining the best rehabilitation program for each shoulder after cuff repair surgery remains. Our practice is to maximize protection of the repair, accepting the possible risk of stiffness because stiffness after a cuff repair is easier to manage than failure of the repair.


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