Evaluation of 3 different rehabilitation protocols after rotator cuff repair, and the effectiveness of pool therapy: a randomized control study

Objectives: Exercises performed in water have shown to improve strength and range of motion in various joint pathologies. This study aims to identify the best rehabilitation protocol for patients who undergo arthroscopic rotator cuff repair, and the effectiveness of a pool therapy protocol. Methods: Patients who underwent arthroscopic rotator cuff repair for small to medium sized rotator cuff tears, with small to moderate retraction of the affected tendon and who underwent surgery between 2013 and 2016, were randomized in 3 different groups at the time of surgical indication. Groups: 1. Patients who had rehabilitation with physical therapy and no aquatic protocol; The "Dry group", 2. Patients who had rehabilitation with physical therapy, including an aquatic protocol; The "Pool Group", 3. Patients who had self-rehabilitation alone, with no physical therapist. The "Self Group" follow-up: all patients were assessed by an independent observer. The mean outcome measures consisted of pre and postoperative SSV, Constant score, and patient satisfaction. Patients were followed-up at 4, 8 and 12 weeks postoperatively, as well as in 1 and 2 years. Results: Group 1 (Dry group) and Group 2 (Pool group) showed better Constant scores 2 months postoperatively, although this was not statistically significant. However, patients in group 2 (Pool group) showed statistically better Constant scores and overall satisfaction 3 months postoperatively. All the groups had similar results 6 months, 1 year and 2 years postoperatively, with slightly better outcomes for the Dry and Pool groups compared to the Self group. Conclusion: Water therapy after rotator cuff repair provides better early results compared to traditional "dry" rehabilitation or self-exercise therapy. The results remain better for patients who had pool or dry rehabilitation 1 and 2 years postoperatively, although the difference is not statistically significant in the long term.