Tuesday, January 31, 2017

How long does it take to recover from rotator cuff repair?

Speed of recovery after arthroscopic rotator cuff repair

These authors reviewed 627 patients who underwent arthroscopic rotator cuff repair.

At 3 months, the group demonstrated 74% of improvement in pain, 45% to 58% of functional improvement,  and 22% of elevation improvement

At 6 months, the group demonstrated 89% of improvement in pain, 81% to 88% of functional improvement,and 78% of elevation improvement.

The plateau of maximum recovery for pain, function, and motion occurred at 1 year.

The authors used several outcome scores, all showing similar results. Here are their data for the SST.

Larger tears had a slower speed of recovery. Smaller tears had higher motion and functional scores. Tear size did not influence pain levels. In this study, we do not know what percent of the repairs had re-tears. 

Comment: This study provides a realistic view of the rate of recovery after cuff repair surgery based on a large single-surgeon experience. It takes time to recover from a cuff repair.
In considering the generalizability of these data, we must keep in mind that the results of high volume surgeons are generally superior to those of occasional cuff repair surgeons, due in part to enlightened patient selection and standardized surgical and postoperative care. 

It is interesting to note the conservative approach to rehabilitation used by this surgeon:

"Postoperatively, all patients were maintained in a shoulder immobilizer for 6 weeks. However, patients were relegated into 1 of 2 rehabilitation groups based on the retraction grade of the tear. Patients with a grade 1 tears were started in a physical therapist–directed protocol that allowed early active assist and passive motion beginning at the first therapy visit within 1 week of surgery. However, patients with grade 2 and grade 3 tears were placed in a self-directed home program for the first 3 months that called for pendulum exercises only for the first 6 weeks, followed by active assisted stretching exercises for the subsequent 6 weeks. No strengthening exercises were prescribed for the first 3 months for all patients."

This experienced-based conservative approach is in marked contrast to the rather fanciful assumptions use in the model referred to in the post Does rotator cuff repair save the U.S. money?

Finally, it is of interest to note the similarity in the rate of recovery as reflected by different outcome scores as shown in this plot of their data. It appears that these different scales are measuring much the same characteristics of the shoulder.