Is early mobilization necessary in isolated rotator cuff repair? Results of a prospective series of 1,200 cases

Abstract

Objectives:Non-healing of rotator cuff tears is estimated to be between 5 and 20%. Rehabilitation protocols vary. Some advocate early rehabilitation. The aim of the study was to verify whether rapid recovery of mobility was not associated with a higher rate of non-healing.Methods:We conducted a single-center prospective study. The primary inclusion criterion was first-line arthroscopic repair of an isolated complete cuff tear without retraction (Patte 1) or fatty degeneration (Goutallier - less than 2). It was the same surgeon, the same surgical technique (double row) and the same rehabilitation protocol (self-mobilization, hands together). Patients were seen again by an evaluator other than the surgeon. We analyzed passive elevation and external rotation (ER1) mobility and pain at 6 weeks, 3 months, and 6 months, active mobilities at 3 months and 6 months, and the Constant score at 6 months. Tendon healing was assessed at six months by ultrasound according to Sugaya’s classification (grouping 1/2/3 healed and 4/5 unhealed).Results:1,200 patients were included, 101 were excluded (lost to follow-up or missing data at one of the reviews). The healing rate was 85.7%. We noted a statistically significant difference between the healed and unhealed groups for passive elevation at 6 weeks (128° vs 142° p <0.0001), passive ER1 (23°/32°, p <0.0001). As well as at 3 months for passive elevation (149°/155°, p = 0.0005) for ER1 (43°/48°, p = 0.0008). No difference in pain between the 2 groups (at each review) nor in the final Constant score (72.3 vs 70.2)Conclusion:Patients with poorer passive joint mobility at 6 weeks and 3 months postoperatively had a better healing rate at 6 months. This clear correlation is an indication that we should reflect on the earliness of rehabilitation after rotator cuff repair.