The Effect of Immobilization without Passive Exercise after Rotator Cuff Repair (SS-27)

Abstract

While animal studies showed better healing in longer duration of immobilization without passive motion after rotator cuff (RC) repair, there were rare clinical studies to support. The purpose of this study was to see clinical results of immobilization in rotator cuff repair and to see if there was any difference between duration of immobilization. One-hundred patients who underwent arthroscopic single-row repair for medium-to-large RC tear were prospectively randomized to 4 or 8 weeks of immobilization. During the immobilization period after the surgery, any passive or active range-of-motion exercise including pendulum exercise was not allowed. According to the Intention-to-treat protocol and full analysis set, a total of 88 patients were evaluated after exclusion of 12 patients who did not have any clinical visit after 6 months postoperatively. Range-of-motion (ROM), Pain Visual Analogue Scale (PVAS), American Shoulder and Elbow Surgeon’s (ASES) score, Constant score, patient’s satisfaction, and re-tear rate were compared between 4-weeks (4W) and 8-weeks (8W) group. All enrolled patients were contacted by telephone to investigate the clinical outcome measurements with PVAS, ASES score, and satisfaction. The real duration of immobilization was 4.1 weeks in 4W and 7.2 weeks in 8W group. All the preoperative variables including demographic data, ROM, clinical scores, and MRI features were comparable between two groups. There were 9 cases (10%) of full-thickness retear and 88% of patients rated their results as excellent or good. There were 7 delaminated partial re-tears and 5 full-thickness re-tears in 4W group, and 7 delaminated partial re-tear and 4 full-thickness re-tear in 8W group without statistical difference on postoperative MRI (p=0.839). At 6 months and final follow-up, both groups showed no differences in ROM, PVAS, ASES score, Constant score, and patient satisfaction. On the final survey for all 98 patients interviewed by telephone at mean 35 months, PVAS, ASES score, and patient’s satisfaction showed no difference as well. Immobilization without motion exercise after arthroscopic rotator cuff repair would result in 10% of failure to heal and good clinical results without increase of stiffness despite of single-row repair for medium-to-large tear. However, immobilization more than 4 weeks seemed have no effects on the healing and ROM.