Return to Sport After Arthroscopic Rotator Cuff Repair in Middle-Aged and Elderly Swimmers

Abstract

Background: No reports have been published on the clinical outcomes, including return to sport, after rotator cuff repair in middle-aged and elderly swimmers with rotator cuff tears. Purpose: To retrospectively investigate clinical outcomes and return to sport after arthroscopic rotator cuff repair in middle-aged and elderly swimmers. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic rotator cuff repair and met the following criteria were included: (1) age older than 45 years, (2) rotator cuff tears confirmed during surgery, (3) arthroscopic suture bridge rotator cuff repair, (4) primary surgery, and (5) swam more than once a week before surgery. The exclusion criteria were as follows: (1) irreparable large and massive tears, (2) shoulder instability, (3) arthritis or rheumatic disorders, or (4) less than 2-year follow-up. We investigated functional outcomes including range of motion; the University of California, Los Angeles (UCLA) score; the American Shoulder and Elbow Surgeons (ASES) score; return to swimming; and the return rates for each style of swimming. In addition, the functional outcomes and findings of magnetic resonance imaging were compared between the group with complete return and the group with incomplete or failed return. Results: A total of 32 shoulders in 31 middle-aged and elderly swimmers (5 males, 26 females) were included. The mean age was 65 years (range, 47-78 years), and the mean follow-up was 47 months (range, 24-86 months). Return to swimming was achieved in 31 (97%) shoulders at a mean of 8 months (range, 3-24 months), and complete return was achieved in 18 (56%) shoulders at a mean of 12 months (range, 3-24 months). The return rate was 97% for freestyle, 83% for breaststroke, 74% for backstroke, and 44% for butterfly stroke. Postoperative UCLA and ASES scores were significantly higher in the group with complete return than in the group with incomplete or failed return ( P = .001 and .01, respectively). Postoperative forward elevation was significantly better in the complete return group ( P = .01). Conclusion: This study demonstrated that 97% of elderly swimmers who underwent arthroscopic rotator cuff repair could return to swimming. The complete return rate was 56%; however, the group with incomplete or failed return showed poorer active forward elevation. Freestyle had the highest complete return rate, whereas the butterfly stroke had the lowest return rate. It may be important to achieve good active forward elevation postoperatively to return to swimming.

Rehabilitation and Return to Play of the Athlete after an Upper Extremity Injury

“…Many rehabilitation protocols after rotator cuff repair recommend a period of 3 to 4 weeks of immobilization in a sling postoperatively. [30][31][32][33][34][35][36][37][38][39][40][41] However duration of immobilization is controversial and some studies indicate early mobilization can be associated with improved outcomes. 42 During this phase, there is significant heterogeneity in the level of movement recommended by authors in the literature with varying degrees of passive mobilization of the shoulder.…”

“…42 During this phase, there is significant heterogeneity in the level of movement recommended by authors in the literature with varying degrees of passive mobilization of the shoulder. 30,35,40,41,43,44 Athletes will progress through the rehabilitation protocol; further ROM and muscular strengthening will progress between 6 to 12 weeks after surgery and progression to sport specific activities will range from 3 to 6 months. 30,31,33,35,[43][44][45][46]…”

“…In contrast, nonoverhead athletes and recreational athletes were able to RTP after rotator cuff repair more frequently than overhead throwers. In a study of 33 middle-aged and elderly swimmers, Shimada et al 40 found that 97% were able to return to swimming at a mean of 8 months after surgery. In the study of 22 CrossFit athletes, 100% of patients returned to training after a mean of 8.7 months.…”

Evidence-Based Musculoskeletal Care for Swimmers

“…Swimmer-specific surgical outcome studies are sparse, although the existing studies are presented above. A surgical procedure is a last resort because patients often have difficulty resuming their preoperative activities 43,44,56 .…”

Return-to-Sport Criteria After Upper Extremity Surgery in Athletes—A Scoping Review, Part 1: Rotator Cuff and Shoulder Stabilization Procedures

“…a HAGL, humeral avulsion of the glenohumeral ligament.||References 2,5,10,15,21,24,31,33,46,49,54,55,58,59. { used as the RTS criterion in 23 of 52 studies (44%).…”