ANALYSIS THE RESULTS OF SURGICAL TREATMENT AND EARLY REHABILITATION OF PATIENTS WITH MASSIVE TEARS THE ROTATOR CUFF...

The aim of the study was to evaluate the treatment outcomes in patients who underwent arthroscopic repair of large and massive rotator cuff tears and underwent rehabilitation at different stages of the recovery process. The clinical study group consisted of 88 patients, with an age range of 47 to 68 years (mean age 52,7±9,5 years). All patients underwent a double-row repair of the rotator cuff tendons and tenodesis or tenotomy of the long head of the biceps tendon under arthroscopic guidance. The results were assessed using the Constant Shoulder Score and the Oxford Shoulder Score scales at 6 and 12 months after the surgery. A total of 88 patients were selected, with 50 patients in the main group (MG) who had a 6-week immobilization period. The control group (CG) consisted of 38 patients who had a shortened immobilization period of 3-4 weeks due to patient preference or recommendations from other rehabilitation centers where patients underwent rehabilitation. Shoulder immobilization was performed using a standard sling with a triangular pillow and a 15° abduction angle in the shoulder joint. Following the surgeon's recommendation, all patients were offered a rehabilitation program consisting of three periods: immobilization (0-6 weeks), functional (6-12 weeks), and training (>12 weeks) periods. Comparative analysis of the treatment results using the Oxford Shoulder Score scale showed that significantly better results were obtained in the MG patients (41,5±2,1 points) compared to the CG patients (34,2±3,6 points) at 6,2±1,2 months (p˂0.05). Comparative analysis of the treatment results using the Oxford Shoulder Score scale at 12,2±1,3 months showed that there were no statistically significant differences between the MG and CG results (MG - 44,5±2,2 and CG - 42,4±3, p>0,05). Similarly, according to the Constant Shoulder Score scale, better results were observed in the MG both at 6 months and 12 months after the surgery (excellent in 82% of MG vs 36.8% in CG, good in 18% of MG vs 57.9% in CG, respectively). Thus, in the short term, early activation of the operated joint leads to delayed healing of the operated tissues and worsening of joint function, as confirmed by the comparative analysis of the examined groups. Significant advantages of prolonged immobilization (at least 6 weeks) were found in short-term observation (up to 6 months), and no differences in functional outcomes were observed in the long term during the follow-up at 12 months.