Keener, J Bone Joint Surg Am 2014 - Rehabilitation Following Arthroscopic Rotator Cuff Repair: A Prospective Randomized Trial of Immobilization Compared with Early Motion
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Rehabilitation Following Arthroscopic Rotator Cuff Repair: A Prospective Randomized Trial of Immobilization Compared with Early Motion
Keener, Yamaguchi, et al.·J Bone Joint Surg Am·2014·222 citations·RCT
Keener and colleagues compared early passive motion with six weeks of immobilization after arthroscopic rotator cuff repair, judged by function and ultrasound evidence of tendon healing.
Randomized trial at Washington University, St. Louis, of 124 patients under 65 treated over 30 months, with clinical follow‑up to 24 months.
Methods
Design
Prospective randomized trial
Therapeutic Level I
Setting
Washington University Shoulder and Elbow Service, St. Louis
Patients
124 patients under 65
Full‑thickness superior or posterior tear up to 30 mm, on preoperative ultrasound
Arthroscopic double‑row repair
Groups
Traditional rehabilitation with early motion (65)
Immobilization with motion delayed 6 weeks (59)
Follow-up
Clinical review at 6, 12 and 24 months
Ultrasound at a minimum of 12 months
114 of 124 at final clinical follow‑up
Outcomes
VAS pain
ASES score
Simple Shoulder Test
Relative Constant score
Strength
Tendon integrity on ultrasound
Key Findings
Tendon healing did not differ by protocol: 50 of 53 repairs (94%) were intact after immobilization vs 57 of 63 (90%) after early motion (p = 0.46).
Early motion gave better active elevation (136° vs 123°, p = 0.02) and external rotation (47.0° vs 40.1°, p = 0.05) at 3 months.
From 6 months onward, pain, motion, strength and every functional score were similar in the two groups. However, the trial was not powered for clinical outcomes.
ASES and SST scores leveled off by 12 months. In contrast, the relative Constant score kept improving at every time point.
Two patients, one from each group, had an early retear and were revised to a latissimus dorsi transfer or a reverse shoulder arthroplasty.
To reach significance for the observed 90% vs 94% healing gap at power 0.8 and alpha 0.05, the trial would have needed 721 patients per group.
Board pearl
Six weeks of immobilization after small or medium cuff repair did not appear to increase the risk of shoulder stiffness. No patient in either arm needed surgery for recalcitrant stiffness.
Authors' conclusion
Arthroscopic repair of small and medium full-thickness rotator cuff tears results in reliable improvements in clinical outcomes and a high rate of tendon integrity using a double-row repair technique in patients under the age of 65 years. There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome.
Keener and colleagues compared early passive motion with six weeks of immobilization after arthroscopic rotator cuff repair, judged by function and ultrasound evidence of tendon healing.
Randomized trial at Washington University, St. Louis, of 124 patients under 65 treated over 30 months, with clinical follow‑up to 24 months.
Methods
Design
Prospective randomized trial
Therapeutic Level I
Setting
Washington University Shoulder and Elbow Service, St. Louis
Patients
124 patients under 65
Full‑thickness superior or posterior tear up to 30 mm, on preoperative ultrasound
Arthroscopic double‑row repair
Groups
Traditional rehabilitation with early motion (65)
Immobilization with motion delayed 6 weeks (59)
Follow-up
Clinical review at 6, 12 and 24 months
Ultrasound at a minimum of 12 months
114 of 124 at final clinical follow‑up
Outcomes
VAS pain
ASES score
Simple Shoulder Test
Relative Constant score
Strength
Tendon integrity on ultrasound
Key Findings
Tendon healing did not differ by protocol: 50 of 53 repairs (94%) were intact after immobilization vs 57 of 63 (90%) after early motion (p = 0.46).
Early motion gave better active elevation (136° vs 123°, p = 0.02) and external rotation (47.0° vs 40.1°, p = 0.05) at 3 months.
From 6 months onward, pain, motion, strength and every functional score were similar in the two groups. However, the trial was not powered for clinical outcomes.
ASES and SST scores leveled off by 12 months. In contrast, the relative Constant score kept improving at every time point.
Two patients, one from each group, had an early retear and were revised to a latissimus dorsi transfer or a reverse shoulder arthroplasty.
To reach significance for the observed 90% vs 94% healing gap at power 0.8 and alpha 0.05, the trial would have needed 721 patients per group.
Board pearl
Six weeks of immobilization after small or medium cuff repair did not appear to increase the risk of shoulder stiffness. No patient in either arm needed surgery for recalcitrant stiffness.
Authors' conclusion
Arthroscopic repair of small and medium full-thickness rotator cuff tears results in reliable improvements in clinical outcomes and a high rate of tendon integrity using a double-row repair technique in patients under the age of 65 years. There is no apparent advantage or disadvantage of early passive range of motion compared with immobilization with regard to healing or functional outcome.