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Rehabilitation variability after rotator cuff repair.
Michael D Galetta1, Rachel E Keller1, Orlando D Sabbag1
1Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Journal of Shoulder and Elbow Surgery
|January 8, 2021
Summary
Online rotator cuff repair (RCR) rehabilitation protocols show significant variability and are often more aggressive than established guidelines. Further research is needed to standardize RCR protocols for optimal patient outcomes.
Area of Science:
- Orthopedic Surgery
- Physical Therapy
- Rehabilitation Medicine
Background:
- Standardized postoperative rehabilitation protocols are increasingly recognized as crucial for optimal patient outcomes.
- Despite the American Society of Shoulder and Elbow Therapists (ASSET) guidelines published in 2016, optimal rotator cuff repair (RCR) rehabilitation remains debated.
- This study addresses the need for clarity in RCR rehabilitation by analyzing online protocols.
Purpose of the Study:
- To assess the variability of online rotator cuff repair (RCR) rehabilitation protocols.
- To evaluate the congruence between online RCR protocols and the ASSET consensus statement.
- To identify differences in online RCR protocols published before and after 2016.
Main Methods:
- A web-based search identified publicly available RCR rehabilitation protocols from academic orthopedic institutions.
- Protocols were categorized by tear size and analyzed for demographics, adjunctive therapy, immobilization, range of motion, and strengthening.
- Findings were compared against ASSET recommendations, and protocols were grouped by publication date (pre- and post-2016).
Main Results:
- Only 8.5% of ACGME institutions provided online RCR rehabilitation protocols, with 66 protocols collected.
- Online protocols recommended significantly more aggressive rehabilitation (earlier immobilization, ROM, and strengthening initiation) compared to ASSET guidelines (P < .001).
- Protocols published after 2016 showed a trend toward more conservative recommendations but remained more aggressive than ASSET guidelines.
Conclusions:
- Significant variations persist in online rotator cuff repair (RCR) rehabilitation protocols, despite ASSET's standardization efforts.
- Online RCR rehabilitation protocols generally recommend more aggressive approaches than the ASSET consensus statement.
- Further research is essential to address these discrepancies and refine RCR rehabilitation guidelines.
