Rehabilitation variability after rotator cuff repair. 2021

Michael D Galetta, and Rachel E Keller, and Orlando D Sabbag, and Shannon E Linderman, and Matthew S Fury, and Giovanna Medina, and Evan A O'Donnell, and Timothy T W Cheng, and Elan Harris, and Luke S Oh
Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.

BACKGROUND There has been increasing recognition of the importance for standardized postoperative rehabilitation protocols. Despite published guidelines in 2016 by the American Society of Shoulder and Elbow Therapists (ASSET), optimal postoperative rehabilitation after rotator cuff repair (RCR) remains an area of active academic debate. The goals of this study were (1) to assess the variability of RCR rehabilitation protocols published online, (2) to study the congruence between online RCR rehabilitation protocols and the ASSET consensus statement, and (3) to identify differences in online RCR rehabilitation protocols from before and after 2016. METHODS A web-based search was conducted for publicly available RCR rehabilitation protocols from websites of all Accreditation Council for Graduate Medical Education (ACGME) academic orthopedic institutions. A supplemental 10-page Google search was also performed with the search terms "rotator cuff repair rehabilitation protocol." Collected protocols were grouped by tear size (small/medium or large/massive) and examined for information relating to the following categories: protocol demographics, adjunctive therapy use, immobilization/range of motion, and strengthening. Findings were compared to the ASSET statement's recommendations. Protocols published before and after ASSET's 2016 publication were compared for differences. RESULTS A total of 66 online RCR rehabilitation protocols were collected. Only 16 of 187 (8.5%) ACGME institutions provided online RCR rehabilitation protocols. The collected protocols recommend more aggressive rehabilitation in comparison to ASSET, specifically regarding immobilization time, passive range of motion initiation, active assisted range of motion initiation, and strengthening initiation (P < .001). Protocols published after 2016 trended toward more conservative recommendations in comparison to protocols published before 2016. Regardless of this trend, the majority of these recommendations were still largely more aggressive than ASSET's recommendations. CONCLUSIONS Despite an attempt by ASSET to provide standardization, this study highlights the marked variations that still exist regarding RCR rehabilitation. Additionally, online RCR rehabilitation protocols tend to make more aggressive recommendations than the ASSET consensus statement. Further research is needed to address these variations and to either validate, alter, or reject the ASSET recommendations.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070636 Rotator Cuff Injuries Injuries to the ROTATOR CUFF of the shoulder joint. Glenoid Labral Tears,Rotator Cuff Tears,Rotator Cuff Tendinitis,Rotator Cuff Tendinosis,Cuff Injury, Rotator,Glenoid Labral Tear,Injury, Rotator Cuff,Labral Tear, Glenoid,Labral Tears, Glenoid,Rotator Cuff Injury,Rotator Cuff Tear,Rotator Cuff Tendinitides,Rotator Cuff Tendinoses,Tear, Glenoid Labral,Tear, Rotator Cuff,Tears, Rotator Cuff,Tendinitis, Rotator Cuff,Tendinoses, Rotator Cuff,Tendinosis, Rotator Cuff
D001178 Arthroplasty Surgical reconstruction of a joint to relieve pain or restore motion. Bone Tunnel Enlargement,Bone Tunnel Widening,Arthroplasties,Bone Tunnel Enlargements,Bone Tunnel Widenings,Enlargement, Bone Tunnel,Tunnel Enlargement, Bone,Tunnel Widening, Bone,Widening, Bone Tunnel
D001182 Arthroscopy Endoscopic examination, therapy and surgery of the joint. Arthroscopic Surgical Procedures,Surgical Procedures, Arthroscopic,Arthroscopic Surgery,Surgery, Arthroscopic,Arthroscopic Surgeries,Arthroscopic Surgical Procedure,Arthroscopies,Procedure, Arthroscopic Surgical,Procedures, Arthroscopic Surgical,Surgeries, Arthroscopic,Surgical Procedure, Arthroscopic
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017006 Rotator Cuff The musculotendinous sheath formed by the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. These help stabilize the HUMERAL HEAD in the GLENOID CAVITY of the SCAPULA and allow for rotation of the SHOULDER JOINT about its longitudinal axis. Cuff, Rotator,Infraspinatus,Subscapularis,Supraspinatus,Teres Minor,Rotator Cuffs

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