Does Slower Rehabilitation After Arthroscopic Rotator Cuff Repair Lead to Stiffness? (SS-22)

Abstract

Early passive range of motion (PROM) has been advocated following open rotator cuff repair to prevent stiffness. We sought to examine the effect of a conservative post-operative regimen. Six weeks of sling immobilization after arthroscopic rotator cuff repair did not result in stiffness at one year follow-up. Additionally, patients with perioperative stiffness trended toward better tendon healing rates. Early passive range of motion (PROM) has been advocated following open rotator cuff repair to prevent stiffness. Because of concern over re-tear rates after arthroscopic repair, many authors have advocated slower rehabilitation. We sought to examine the effect of a conservative post-operative regimen, sling immobilization for 6 weeks, on ROM following arthroscopic cuff repair. 56 patients with full-thickness rotator cuff tears were prospectively followed for 1 year. Patients with preoperative stiffness were excluded. ROM was assessed preoperatively and at 2, 6, 12, 24, and 52 weeks postoperatively. Pre- and postoperative ASES and Constant scores were recorded. 43 patients (77%) had an MRI at one year postoperatively to assess repair integrity. During the first 6 weeks postoperatively 43 patients (77%) had “good” PROM (elevation > 100° and external rotation (ER) >30°), while 13 (23%) were “stiff” (elevation < 100° and/or ER <30°). No patients were stiff at one year. 44% of the repairs were intact at 1 year by MRI. There was a trend for better healing in the “stiff” group: 70% of repairs were intact on MRI, compared to 38% in the “good ROM” group (p=0.13). There was no difference in ASES, Constant scores, or ROM at 1 year between groups. Six weeks of immobilization after arthroscopic rotator cuff repair does not appear to result in long-term stiffness. Additionally, patients with perioperative stiffness trended toward better tendon healing. Early PROM is not necessary to avoid stiffness after arthroscopic rotator cuff repair, and may have a detrimental effect on tendon healing.