[mtomaino]

"Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness"
was published in the October issue of the Journal of Shoulder and Elbow Surgery by Brad Parsons, Evan Flatow and colleagues from the Mt Sinai shoulder group in NYC.

These authors hypothesized that conservative rehabilitation (similar to what was included in my post above) does not result in long-term stiffness AND improves rates of rotator cuff tendon healing.

43 patients were retrospectively evaluated following arthroscopic repairs of full thickness rotator cuff tears and an initial period of 6 weeks in a sling without any shoulder motion.At 6-8 weeks of follow-up, patients were deemed either "stiff" (if they had less than 100 degrees of forward elevation and 30 degrees of external rotation, passively) or "nonstiff" (all others).

At 6-8 weeks formal PT started, which included only passive range of motion, and at 3 months active motion and strengthening began. At 1 year MRI was obtaied to assess the integrity of the tendon repair (had the tendon healed?)

Results were very interesting. 23% of patients were deemed "stiff" at 6 weeks, but at 1 year follow-up, there was no difference in range of motion between the "stiff" and "nonstiff" patients. Further, outcome scores were similar.

MRI suggested a lower re-tear rate in "stiff" patients (70% tendon in tact in stiff group versus 36% in the nonstiff group.)

In short, this study shows that sling immobilization for 6 weeks after arthroscopic rotator cuff repair does not result in long-tern stiffness, and may improve the rate of tendon healing.

How does this impact on my practice? Well, if I am pleased with the quality of your tendon and the security of the repair, I will typically start passive range of motion the 1st 6 weeks. Afterall, the "stiff" group was no different at 1 year----and for many patients, they do not want to work to overcome any loss of motion. But, it's reassuring to know that if we need to be extra safe---adhering to a no motion program for the 1st 6 weeks may not only help prevent re-tears, but it does not appear to result in long-term stiffness. I will routinely employ this conservative approach when I repair large and massive tears.