Accelerated PT following transtendinous RCR is associated with significant improvement in AROM at 6 weeks and 3 months postoperatively. Further, the early motion may help obviate the development of severe postoperative stiffness without any evidence of higher rotator cuff retear rates.
McBroom TJ, Abraham PF, Varady NH, Kucharik MP, Eberlin CT, Best MJ, Martin SD. Accelerated Versus Standard Physical Therapy in Patients with Transtendinous Rotator Cuff Repair: A Propensity-Matched Cohort Study. J Shoulder Elbow Surg. 2021 Dec 2;S1058-2746(21)00818-1. doi:10.1016/j.jse.2021.10.039. Online Ahead of Print.
Background: Partial-thickness rotator cuff tears that remain symptomatic despite conservative management can be repaired operatively through a transtendinous approach. While transtendinous repairs have been linked to superior long-term biomechanical outcomes compared to other surgical techniques, they are classically associated with early postoperative stiffness and a slower rate of recovery.
Purpose: To examine the impact of expediting the physical therapy (PT) regimen following transtendinous repair on postoperative range of motion (ROM) and complications.
Methods: The first 61 patients to receive accelerated PT following transtendinous repair were compared to a historical cohort of 61 patients that underwent standard postoperative management. The patients were propensity matched on age, sex, smoking status, and biceps procedure performed at the time of rotator cuff repair (RCR). Primary outcome measures included active range of motion (AROM) in forward flexion, abduction, external rotation, and internal rotation at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively. Secondary outcome measures included development of severe stiffness or symptomatic rotator cuff retear at 1 year follow-up. Patients with full-thickness tears and those undergoing revision surgery or tear-completion and repair were excluded.
Results: The accelerated PT cohort showed significantly increased AROM at 6 weeks and 3 months postoperatively. At 6 weeks, AROM in forward flexion (137.0° vs. 114.9°; p<0.001), abduction (126.1° vs. 105.3°; p=0.009), and external rotation (51.7° vs. 36.5°; p=0.005) were all significantly higher in the accelerated PT cohort. A similar increase was seen at 3 months, with superior forward flexion (147.5° vs. 134.0°; p=0.01) and external rotation (57.7° vs. 44.0°; p=0.008) in patients who received accelerated PT. Severe postoperative stiffness was significantly less common in the accelerated PT cohort (3.3% vs 18.0%; p=0.02) and there were no symptomatic retears (0.00%) in the accelerated PT cohort as compared to 1 symptomatic retear (1.64%) in the standard PT cohort (p=1.00).
Conclusion: Accelerated PT following transtendinous RCR is associated with significant improvement in AROM at 6 weeks and 3 months postoperatively. Further, the early motion may help obviate the development of severe postoperative stiffness without any evidence of higher rotator cuff retear rates.
Keywords: accelerated PT; range of motion; retear; rotator cuff repair; stiffness; transtendinous.