A Level I randomized trial comparing two rehab protocols after arthroscopic repair of small and medium (<30 mm) full-thickness rotator cuff tears. 124 patients under 65 were randomized to early passive motion or six weeks of immobilization. The question: does protecting the repair with immobilization improve tendon healing or function?
The clinical worry driving immobilization was that early motion causes repair-site micromotion and gap formation, hurting tendon healing. This trial shows that fear is unfounded for small and medium tears in patients under 65.
Either approach is safe. Early passive motion buys faster motion recovery at 3 months with no healing penalty, while immobilization avoids that early motion but does not cause more stiffness and may reduce early therapy costs.
The key caveat: these were small/medium tears, double-row repairs, mean age 55. Do not extrapolate to massive tears or older patients, where the authors note the healing benefit of immobilization may still matter.
One durable pearl separate from the protocol debate: early motion should be gentle and passive. Aggressive manual or unrestricted self-directed stretching has been tied to higher retear rates.
A Level I randomized trial comparing two rehab protocols after arthroscopic repair of small and medium (<30 mm) full-thickness rotator cuff tears. 124 patients under 65 were randomized to early passive motion or six weeks of immobilization. The question: does protecting the repair with immobilization improve tendon healing or function?
The clinical worry driving immobilization was that early motion causes repair-site micromotion and gap formation, hurting tendon healing. This trial shows that fear is unfounded for small and medium tears in patients under 65.
Either approach is safe. Early passive motion buys faster motion recovery at 3 months with no healing penalty, while immobilization avoids that early motion but does not cause more stiffness and may reduce early therapy costs.
The key caveat: these were small/medium tears, double-row repairs, mean age 55. Do not extrapolate to massive tears or older patients, where the authors note the healing benefit of immobilization may still matter.
One durable pearl separate from the protocol debate: early motion should be gentle and passive. Aggressive manual or unrestricted self-directed stretching has been tied to higher retear rates.