Range of Motion after Arthroscopic Rotator Cuff Repair

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March 15, 2015
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Blog, Compliance, Evidence-Based Practice, Shoulder

Evidence-Based Practice – Issue 3-2015

Effects of Slow and Accelerated Rehabilitation Protocols on Range of Motion after Arthroscopic Rotator Cuff Repair

Article.  Duzgun, I., et al. Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair.  Acta Orthop Traumatol Turc.  2014; 48(6):  642-648

Purpose.  The purpose of this study was to investigate the effect of the early initiation of passive and active range of motion exercises following arthroscopic rotator cuff repair.  

Study Design.  Quasi-randomized, clinically controlled trial.

Methods.

  • Subjects
    • 40 subjects were followed post-operatively for 24 months after arthroscopic rotator cuff repair surgery
    • Subjects were assigned to an Accelerated or a Slow rehabilitation protocol
      • 19 subjects in Accelerated group (17 female; 2 male)
        • Age:  57.68 years (40-69)
        • Height:  1.56 m
        • Weight:  75 kg (55-92 kg)
      • 21 subjects in Slow group (17 female; 4 male)
        • Age:  57.68 years (39-75 years)
        • Height:  1.56 m
        • Weight:  7 kg (54-100 kg)
  • No history of central nervous system disorder
  • No history of peripheral nerve disorder
  • No history of psychological disorder
  • Must be willing to comply with rehabilitation protocol
  • Accelerated Protocol
    • 3x/week for 6 weeks (initiated at the 2nd post-operative week)
    • Week 2:
      • Soft tissue mobilization and ROM exercises for scapulothoracic and glenohumeral joints
    • Week 3:
      • AROM for scapular plane elevation, flexion, and abduction
    • Week 4-6:
      • Resistive exercises for shoulder in all planes (Starting with Red Thera-Band)
  • Slow Protocol
    • 3x/week for 14 weeks (initiated at the 2nd post-operative week)
    • Week 4:
      • Soft tissue mobilization and ROM exercises for scapulothoracic and glenohumeral joints
      • Week 6:
        • AROM for scapular plane elevation, flexion, and abduction
      • Week 8-14:
        • Progressive Resistive exercises for shoulder in all planes (Starting with Red Thera-Band)
  • Data Collection
    • PROM measures from supine position with goniometer
      • Flexion
      • Abduction
      • Internal Rotation
      • External Rotation
    • AROM Measures
      • Active total elevation
      • Distance reached behind back (internal rotation)
    • Repeated at the 3rd, 5th, 8th, 12th, 24th postoperative week
  • Data Analysis
    • Repeated Measure ANOVA with Student t-test.

Results

  • With the exception of internal rotation, active elevation, and active internal rotation there were no statistical differences across the weeks.
  • Peak differences between groups for internal rotation were between 8th and 12th week
  • See Table below

Rotator Cuff Repair

Clinical Relevance.  

  • No adverse effects were noted in either group
  • PROM and AROM in elevation and internal rotation improved faster in the Accelerated group compared to the Slow group, especially between the 8-12 post-operative weeks
  • No significant differences between groups at 24 week post-op
  • Positives for the Accelerated group
    • Faster return of AROM and PROM
    • Specifically better at returning internal rotation and elevation at 8-12 post-op
    • No adverse effects of impaired healing reported
    • Accomplished the same long-term (24 week post-op) results in 18 visits as the Slow group did in 42 visits
  • Positives for the Slow Group
    • Did not have statistically different results at long-term (24 week post-op) follow-up from the accelerated group
    • No adverse effects of joint stiffness reported
  • There may be benefits to both programs
  • Perhaps selecting elements of both programs would produce an optimal result

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