Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?

Parsons, Bradford O.; Gruson, Konrad I.; Chen, Darwin D.; Harrison, Alicia K.; Gladstone, James N.; Flatow, Evan L.

doi:10.1016/j.jse.2010.04.006

Cited by 168 publications

(150 citation statements)

References 19 publications

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“…Some studies have suggested that HA acts as a physical barrier to tendon repair, whilst others have reported that its actions are only pharmacological. 6,16,17) According to a study by Mitsui et al., 18) HA has been shown to contribute to cell proliferation and to the expression of mRNA encoding pro-collagen alpha 1 (III), which is a precursor to type III collagen, but not of pro-collagen alpha 1 (I), which is a precursor to type I collagen; as a result of their findings, they proposed the adhesion barrier role of HA. Further, Oryan et al 15) reported that HA injection into injured flexor digitorum superficialis of rabbits reduced postoperative bleeding, odema, and inflammatory reactions.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the Anti-adhesive Agent Protescal after Arthroscopic Rotator Cuff Repair: A Retrospective Study

Chung

Yoo

Jeong

2017

Clinics in Shoulder and Elbow

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Background: Many hyaluronic acid (HA)-based anti-adhesive agents have been commercialized for clinical use in the pharmaceutical market. But their efficacy in arthroscopic rotator cuff repairs remains elusive. To determine their efficacy, we performed a comparative analysis of the effects of two hyaluronate/carboxymethylcellulose (CMC)-based anti-adhesive agents, Protescal and Guardix. Methods: We recruited a total of 256 patients who had received an arthroscopic rotator cuff repair at our hospital between January 2014 and March 2015. Among them, 96 patients fulfilled the study's selection criteria and were enrolled as the final population sample. Thirty patients who had received a postoperative injection of Protescal were allocated into Group A. Another 30 patients who had received a postoperative injection of Guardix were allocated into Group B. As controls, 36 patients who did not receive any injection were allocated into Group C. The patients included in this study were aged between 19 and 75 years. For the clinical assessment, we measured the following clinical parameters-the visual analogue scale for pain (PVAS), the American Shoulder and Elbow Surgeons (ASES) score, and the constant score, as well as passive range of motions (ROMs)-at three time-points (preoperatively, 2-month postop eratively, and 6-month postoperatively). Results: We found that Group A compared to Group B tended to show a swifter recovery in passive anterior elevation and in internal rotation by the 2-month postoperative follow-up, but the differences were not statistically significant. Conclusions: We found that the effects of HA/CMC-based injections were minimal after arthroscopic rotator cuff repairs. (Clin Shoulder Elbow 2017;20(1):3-9)

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Section: Discussionmentioning

confidence: 99%

Effectiveness of the Anti-adhesive Agent Protescal after Arthroscopic Rotator Cuff Repair: A Retrospective Study

Chung

Yoo

Jeong

2017

Clinics in Shoulder and Elbow

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“…Data are conflicting on which, if any, of these programs provides superior results. Early aggressive rehabilitation programs have been shown to result in better early outcomes, pain relief, and range of motion however most studies show no difference with regard to these parameters with longer-term followup [60][61][62][63][64][65][66] . One concern with early aggressive rehabilitation programs is that they may be associated with a higher incidence of tendon re-tear.…”

Section: Rehabilitationmentioning

confidence: 99%

Factors affecting healing after arthroscopic rotator cuff repair

Abtahi

Granger

Tashjian

2015

WJO

158

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Rotator cuff repair has been shown to have good longterm results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair. Core tip: Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscletendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing after rotator cuff repair. Smoking cessation and blood glucose and cholesterol control are methods to potentially improve healing rates. Slower, less aggressive rehabilitation programs may improve healing rates with no negative effect on final range of motion and are therefore recommended after arthroscopic repair of most full thickness tears. Finally, no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates after rotator cuff repair. Routine use of these adjuvants is therefore not currently recommended.

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“…4) A number of authors have argued for a prolonged stabilization period, i.e. delayed exercise, after the arthroscopic repair of the rotator cuff, 19,29) but admitted the risk of consequent complications such as a reduced range of motion and the increased rate of stiffness. In fact, Brislin et al 16) reports a rate of stiffness at 8.6% (23 out of 268 patients) after the arthroscopic repair of the rotator cuff.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, such as in the delayed exercise study by Parsons et al, 19) stiffness was defined as forward elevation below 100˚ or external rotation below 30˚. Our reason for newly defining stiffness is two-fold.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] To counter this, early passive exercise was pursued, 18) but the starting period of rehabilitative passive exercise that harbors the minimal risk of both retear and stiffness is still controversial. For instance, Parsons et al 19) favors the delayed passive exercise on the grounds that a prolonged stabilization period of 6 weeks is beneficial for repair and also reduces the risk of stiffness. Thus, our study aims to identify whether delayed passive ex-ercise indeed reduces the rate of retear and increases the rate of stiffness after the arthroscopic repair of the rotator cuff.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Different Starting Periods of Passive Exercise on the Clinical Outcome of Arthroscopic Rotator Cuff Repair

Back¹,

Tae²,

Kim³

et al. 2014

Clin Shoulder Elbow

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Background: To compare the effect of different starting periods of rehabilitative exercise (early or delayed passive exercise) on the rate of retear and other clinical outcomes after the arthroscopic repair of the rotator cuff. Methods: In total, 103 patients who underwent arthroscopic repair of the rotator cuff were included in the study. Determined at 2 weeks post-operation, patients who were incapable of passive forward elevation greater than 90˚ were allotted to the early exercise group (group I: 79 patients; 42 males, 37 females), whilst those capable were allotted to the delayed exercise group (group II: 24 patients; 14 males, 10 females). The group I started passive exercise, i.e. stretching, within 2 weeks of operation, whilst group II started within 6 weeks. The results were compared on average 15.8 months (11-49 months) post-operation using the passive range of motion, the Visual Analog Scale (VAS) pain score, and the University of California at Los Angeles (UCLA) and Constant scores. Stiffness was defined as passive forward elevation or external rotation of less than 30˚ compared to the contralateral side. Follow-up magnetic resonance imaging (MRI) was carried out on average 1 year post-operation and the rate of retear was compared with Sugaya's criteria. Results: There were no differences between the two groups in gender, age, smoking, presence of diabetes, arm dominance, period of tear unattended, pre-operative range of motion, shape and size of tear, degree of tendon retraction, and tendon quality. There were no significant differences in clinical outcomes. Whilst stiffness was more frequent in group II (p-value 0.03), retear was more frequent in group I (p-value 0.028) according to the MRI follow-up. Conclusions: During rehabilitation after the arthroscopic repair of the rotator cuff, the delay of passive exercise seems to decrease the rate of retear but increase the risk of stiffness. (Clin Shoulder Elb 2014;17(2):57-63)

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Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness?

Cited by 168 publications

References 19 publications

Effectiveness of the Anti-adhesive Agent Protescal after Arthroscopic Rotator Cuff Repair: A Retrospective Study

Effectiveness of the Anti-adhesive Agent Protescal after Arthroscopic Rotator Cuff Repair: A Retrospective Study

Factors affecting healing after arthroscopic rotator cuff repair

The Effect of Different Starting Periods of Passive Exercise on the Clinical Outcome of Arthroscopic Rotator Cuff Repair

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