Rehabilitation Variability After Rotator Cuff Repair

J Shoulder Elbow Surg. 2021 Jan 5;S1058-2746(20)30962-9. doi: 10.1016/j.jse.2020.11.016. Online ahead of print.

Abstract

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/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 ten-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<0.001). Protocols published after 2016 trended towards 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.

Conclusion: 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.

Keywords: American Shoulder and Elbow Surgeons (ASES); American Society of Shoulder and Elbow Therapists (ASSET); Immobilization; Range of motion; Rehabilitation protocol; Rotator cuff repair; Strengthening.