Rotator cuff repair protocols: A survey of current New Zealand practice

Abstract

Rehabilitation following surgical rotator cuff repair may enable return to pre-injury function. Optimal recovery is facilitated by the use of post-operative protocols that enhance communication between the surgeon and physiotherapist. The purpose of this study was to describe the rotator cuff repair rehabilitation protocols currently used in New Zealand. Orthopaedic surgeons practising in New Zealand were contacted to determine their current rehabilitation protocols. Length of immobilisation and exercise progression following surgical repair were analysed across weekly timeframes from the day of surgery until nine months post-operatively. The response rate was 55% with protocols received from 31 surgeons. Post-surgical rotator cuff protocols currently in use in New Zealand are predominantly determined by weekly time periods which vary from surgeon to surgeon. Immobilisation was most commonly recommended for four to six weeks, pendular exercises were started the week of surgery, active exercises commenced at six weeks, followed by resisted exercises at twelve weeks. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. Level of detail regarding sets and repetitions of exercises also differed between protocols. Variability across protocols was evident regarding the recommended activity level and time period from surgery. Consideration of tissue quality, size of the tear and strength of the repair is recommended to facilitate optimal results.

An online survey of clinical practice of Brazilian physical therapists on rehabilitation following rotator cuff repair

“…Therefore, we could not calculate view, participation and completion rates. The results from our study for sling usage were similar to those found in the UK, 8 New Zealand 13 and reflect the findings from Vieira et al 10 that 67% of shoulder surgeons recommend an immobilization period of 3e6 weeks. Although it is common practice to use a sling for 6 weeks after surgery, there is no high-quality evidence to support this decision.…”

“…The progression timeline found in our study was similar to two other countries, New Zealand and North America. 9,13 In New Zealand, the majority of the protocols would allow passive exercises in the first week and active exercises at 6e8 weeks. 13 In North America, passive exercise starts within two weeks from surgery and active exercises at 7e10 weeks.…”

“…9,13 In New Zealand, the majority of the protocols would allow passive exercises in the first week and active exercises at 6e8 weeks. 13 In North America, passive exercise starts within two weeks from surgery and active exercises at 7e10 weeks. 9 In contrast, the survey from Littlewood et al 8 showed that in the UK, passive exercises are started in the first three weeks postoperatively, but the progression to active exercises is faster, starting at 4e6 weeks.…”

“…8 In New Zealand and North America, the timing to return to light activities is delayed until 12e16 weeks. 9,13 The studies from New Zealand and North America did not use a clinical case for participants to make a decision, which may the reason for the different timelines to return to light activities. 9,13 The results for returning to more demanding activities were similar in Brazil and the UK; patients are allowed to return around 13 weeks postoperatively.…”

“…9,13 The studies from New Zealand and North America did not use a clinical case for participants to make a decision, which may the reason for the different timelines to return to light activities. 9,13 The results for returning to more demanding activities were similar in Brazil and the UK; patients are allowed to return around 13 weeks postoperatively. In New Zealand returning to activities requiring loadcarrying would be avoided until six months postoperatively 13 ; no data was available from North America.…”