Rehabilitation Protocols for Superior Capsular Reconstruction Are Variable: A Systematic Review

Abstract

Purpose: To screen manuscripts that discuss rehabilitation protocols for patients who underwent superior capsular reconstruction (SCR) to elucidate whether a standard rehabilitation algorithm exists for SCR. Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (i.e., PRISMA) guidelines. PubMed (MEDLINE) and Embase were searched using pertinent Boolean operation terms "superior capsular reconstruction" and "rotator cuff repair rehabilitation," and articles that included rehabilitation protocols following superior capsular reconstruction surgery were reviewed. Two independent reviewers performed the search and quality assessment. Results: A total of 549 articles were yielded after our database search. Fourteen studies fulfilled our inclusion criteria and were included in the review. Study designs included 9 editorials, 3 case series, and 2 case reports. Each study included in this review used a unique rehabilitation algorithm that posed significant variability between the protocols. Four phases were identified to summarize each protocol and were used as a basis of discussiondsling versus brace time (3-6 weeks for comfort/removal vs complete immobilization), passive range of motion (immediately after surgery to initiation at 6 weeks), active range of motion (4-8 weeks), and strengthening/return to full activity (12-52 weeks). Initiation of rehabilitation, length of time spent in each phase, types of exercises, and overarching goals for return to function were significantly variable and were decided upon by the surgeon based on current massive rotator cuff repair protocols. Presently, there is no standard rehabilitation protocol for SCR. Conclusions: SCR is a relatively new procedure that is gaining rapid popularity with promising outcomes. Based on our review, there is no standard rehabilitation protocol in place; thus, it is not possible to recommend an evidence-based rehabilitation protocol following SCR at this time. Level of Evidence: Level V, systematic review of Level IV and V studies.

Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction

“…However, a systematic review reported that many surgeons advocate starting strengthening or resuming activity between 6 and 12 weeks after SCR. 26 Thus, MRI should be performed before the initiation of strengthening exercises to ensure sufficient healing. Furthermore, postoperative serial MRI assessments need to be performed in the future.…”