Postoperative Rehabilitation After Rotator Cuff Repair: A Web-Based Survey of AANA and AOSSM Members

Abstract

Background: Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion.

Hypothesis/purpose: The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation.

Study design: Cross-sectional study; Level of evidence, 4.

Methods: A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013.

Results: The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey.

Conclusion: There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later mobilization.

Keywords: ARCR; arthroscopic; general; physical therapy/rehabilitation; rotator cuff; shoulder.

Figure 1.

Response data showing initial referral to physical therapy (PT) and passive range of motion (PROM) within the first 2 weeks after arthroscopic rotator cuff repair. Unrestricted PROM trended toward later time points, with the majority of surgeons waiting between 4 and 7 weeks postoperatively.

Figure 2.

Initiation of active range of motion (AROM) was most commonly between 7 and 10 weeks. Strengthening was started shortly thereafter, between 6 weeks and 3 months. A trend toward later unrestricted return to activity was shown.

Figure 3.

Seventy percent of surgeons prescribed an accelerated rehabilitation protocol for repairs performed on small (<1 cm) tears and 44% did the same for partial-thickness tears. Delayed rehabilitation protocols were employed by 75% of surgeons when repairing massive (>5 cm) rotator cuff tears.