Are Pulley Exercises Initiated 6 Weeks After Rotator Cuff Repair a Safe and Effective Rehabilitative Treatment?

2016 ◽  
Vol 44 (7) ◽  
pp. 1844-1851 ◽  
Author(s):  
Keith M. Baumgarten ◽  
Roy Osborn ◽  
Will E. Schweinle ◽  
Matthew J. Zens ◽  
Elizabeth A. Helsper

Background: There are few level 1 or 2 evidence studies that examine rehabilitation after rotator cuff repair. Pulleys have been used in postoperative shoulder rehabilitation with the intention of improving range of motion and developing strength. There is a concern that the use of pulleys in rehabilitation of rotator cuff repairs may contribute to excessive scapular motion (scapular substitution) and potentially inferior outcomes. Hypothesis: Rotator cuff repair patients treated with pulley exercises would have increased scapular substitution and inferior patient-determined outcome scores, range of motion, and strength compared with patients treated with an alternative rehabilitation program without pulleys. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 27 patients who underwent rotator cuff repair were randomized to a rehabilitation group that used pulleys initiated 6 weeks postoperatively, and 26 patients followed a rehabilitation protocol without pulleys. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Exclusion criteria were large to massive rotator cuff tears, revision rotator cuff repair, glenohumeral osteoarthritis, adhesive capsulitis, and a symptomatic contralateral shoulder. Outcomes of intervention were patient-determined outcome scores (Western Ontario Rotator Cuff Index [WORC], American Shoulder and Elbow Surgeons [ASES] Shoulder Score, Single Assessment Numeric Evaluation [SANE], Shoulder Activity Level, and Simple Shoulder Test [SST]), range of motion, scapular substitution, and strength. Outcomes were determined at 6, 12, 18, 26, and 52 weeks. A power analysis determined that 22 patients were needed per group to have a power of 0.80, α = 0.05, and effect size of f = 0.5. Results: Both groups had statistically significant improvements in WORC, ASES Shoulder Score, SST, and SANE scores over time after rotator cuff repair ( P < .0001). There were no differences between the interventions for WORC ( P = .18), ASES Shoulder Score ( P = .73), SANE ( P = .5), Shoulder Activity Level ( P = .39), or SST ( P = .36). Both interventions demonstrated improvements in shoulder flexion ( P = .002), abduction ( P = .0001), external rotation ( P = .02), strength ( P ≤ .0002), and scapular substitution ( P ≤ .07) over time after rotator cuff repair. However, there was no difference in range of motion ( P ≥ .26), strength ( P ≥ .20), or scapular substitution ( P ≥ .17) between interventions. Conclusion: A rotator cuff repair rehabilitation program that uses pulleys does not result in inferior outcomes, as determined by patient-determined outcome scores, measurements of scapular substitution, range of motion, and scaption strength. Registration: ClinicalTrials.gov NCT01819909

2019 ◽  
Vol 22 (4) ◽  
pp. 190-194
Author(s):  
Sungwook Choi ◽  
Kyu Bum Seo ◽  
Seungjae Shim ◽  
Ju Yeon Shin ◽  
Hyunseong Kang

Background: The duration of immobilization after arthroscopic rotator cuff repair and the optimal time to commence rehabilitation are still the subject of ongoing debates. This study was undertaken to evaluate the functional outcome and rotator cuff healing status after arthroscopic rotator cuff repair by comparing early and delayed rehabilitation.Methods: Totally, 76 patients with small, medium, and large sized rotator cuff tears underwent arthroscopic repair using the suture-bridge technique. In early rehabilitation group, 38 patients commenced passive range of motion at postoperative day 2 whereas 38 patients assigned to the delayed rehabilitation group commenced passive range of motion at postoperative week 3. At the end of the study period, clinical and functional evaluations (Constant score, the University of California, Los Angeles [UCLA] shoulder score) were carried out, subsequent to measuring the range of motion, visual analogue scale for pain, and isokinetic dynamometer test. Rotator cuff healing was confirmed by magnetic resonance imaging at least 6 months after surgery.Results: No significant difference was obtained in range of motion and visual analogue scale between both groups. Functional outcomes showed similar improvements in the Constant score (early: 67.0?88.0; delayed: 66.9?91.0; <i>p</i><0.001) and the UCLA shoulder score (early: 20.3?32.3; delayed: 20.4?32.4; <i>p</i><0.001). Furthermore, rotator cuff healing showed no significant differences between the groups (range, 6?15 months; average, 10.4 months).Conclusions: Delayed passive rehabilitation does not bring about superior outcomes. Therefore, early rehabilitation would be useful to help patients resume their daily lives.


2011 ◽  
Vol 21 (1-2) ◽  
pp. 121-128 ◽  
Author(s):  
Ching-Hui Wang ◽  
Pi-Chu Lin ◽  
Yu-Tai Lee ◽  
Ching-Wen Chuang ◽  
Shiow-Luan Tsay ◽  
...  

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095799
Author(s):  
Keith M. Baumgarten ◽  
Peter S. Chang ◽  
Will E. Schweinle

Background: There are limited data available to guide patients to their prognosis when glenohumeral chondral lesions are found during arthroscopic rotator cuff repair. Hypothesis: The primary hypothesis was that patients with glenohumeral chondral lesions will have inferior outcomes after arthroscopic rotator cuff repair compared with patients without chondral lesions. The secondary hypothesis was that patients with concomitant chondral lesions will have more severe preoperative symptoms compared with those without chondral lesions. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed of patients who underwent arthroscopic rotator cuff repair between 2008 and 2012. We examined the effects of chondral lesions on patient-determined outcomes, which included the Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), and the Shoulder Activity Level (SAL). Shoulders without chondral lesions were compared with shoulders with chondral lesions to determine whether differences in severity of preoperative symptoms as well as postoperative improvements were statistically significant. Results: A total of 281 shoulders were included from 273 patients, with a mean follow-up of 3.7 years. In total, 90 shoulders (32%) had concomitant chondral lesions in the glenohumeral joint. The presence and degree of chondral damage were not associated with the severity of preoperative symptoms or the amount of improvement after arthroscopic rotator cuff repair, as determined by patient outcome scores. Shoulders with bipolar chondral lesions had less postoperative improvement in their outcome scores compared with shoulders with unipolar lesions, with significant differences found in the SST ( P = .0005), the SANE ( P = .005), and the SAL ( P = .04). Regardless of this, the majority of shoulders with bipolar chondral lesions (80%-92%) had postoperative improvements that superseded the minimal clinically important difference of the ASES, WORC, and SANE. Conclusion: At a mean 3.7-year follow-up, the presence of chondral damage did not appear to negatively affect the improvement in patient-determined outcomes after arthroscopic rotator cuff repair. However, improvement in outcomes was negatively affected by the presence of bipolar chondral lesions.


2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Ignacio Carbonel ◽  
Angel A. Martínez ◽  
Elisa Aldea ◽  
Jorge Ripalda ◽  
Antonio Herrera

Purpose. The purpose of this study was to evaluate the functional outcome and the tendon healing after arthroscopic double row rotator cuff repair of large and massive rotator cuff tears.Methods. 82 patients with a full-thickness large and massive rotator cuff tear underwent arthroscopic repair with double row technique. Results were evaluated by use of the UCLA, ASES, and Constant questionnaires, the Shoulder Strength Index (SSI), and range of motion. Follow-up time was 2 years. Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively and 2 years after repair.Results. 100% of the patients were followed up. UCLA, ASES, and Constant questionnaires showed significant improvement compared with preoperatively (P<0.001). Range of motion and SSI in flexion, abduction, and internal and external rotation also showed significant improvement (P<0.001). MRI studies showed 24 cases of tear after repair (29%). Only 8 cases were a full-thickness tear.Conclusions. At two years of followup, in large and massive rotator cuff tears, an arthroscopic double row rotator cuff repair technique produces an excellent functional outcome and structural integrity.


2008 ◽  
Vol 17 (1) ◽  
pp. S108-S113 ◽  
Author(s):  
Joseph J. Sarver ◽  
Cathryn D. Peltz ◽  
LeAnn Dourte ◽  
Sudheer Reddy ◽  
Gerald R. Williams ◽  
...  

2014 ◽  
Vol 43 (5) ◽  
pp. 1265-1273 ◽  
Author(s):  
Ke-Vin Chang ◽  
Chen-Yu Hung ◽  
Der-Sheng Han ◽  
Wen-Shiang Chen ◽  
Tyng-Guey Wang ◽  
...  

2021 ◽  
Author(s):  
Ijaz Khan ◽  
Manaal Fatima ◽  
Corey Scholes ◽  
Vikram Kandhari ◽  
K.M. Ponnanna ◽  
...  

Background: Return to work (RTW) following arthroscopic rotator cuff repair (aRCR) within New South Wales (NSW), Australia, under compensable schemes has not been reported. Aims: Determine factors affecting RTW status and time in patients treated with aRCR under state-based compensation schemes, compared to those outside such schemes. Methods: Patients undergoing aRCR by one surgeon with minimum 1-year follow-up were grouped into those under (CP) or outside (non-CP) workers or vehicle accident compensation schemes, matched by age and gender. RTW status and time were assessed using chi-square analysis and multivariable linear regression. Results: Of 1054 available patients, 90 CP patients were identified with 29 consented and matched to non-CP (N=29). A higher proportion of CP patients (17.2 vs 0%, P<0.001) never returned to work and a lower proportion resumed pre-injury duties at first RTW (3 vs 52%, P<0.01). Median time to first RTW did not differ between CP and non-CP groups (5.1 vs 4.4, P=0.86). Smoking (P=0.007) and post-injury activity level (P=0.004) were significantly associated with longer time to first RTW, whereas compensation status was not. Conclusions: CP patients undergoing aRCR in NSW are at risk of not returning to work. For those that return, there is no significant difference compared to non-CP in time to first RTW. Particularly, patient and management factors associated with extended time to first RTW have been identified. Interventions aimed at modifiable factors such as smoking cessation and increasing preoperative activity may improve future outcomes.


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