Rotator cuff (RC) tears are a common orthopedic condition among physicians. The incidence of RC tears has been reported to be 25% in people aged sixty years and 50% in people aged eighty years. Conservative treatment options include physical therapy and changes in activity patterns. If conservative treatment fails, then surgical treatment is required. Statistics show that the incidence of rotator cuff tears has increased from 23.5 per 100,000 in 1995 to 83.1 per 100,000 in 2009. This is why rotator cuff repair (RCR) has become the most common shoulder surgery and therefore its postoperative rehabilitation is common in clinical practice. The surgical approach to RCR has also been improving, evolving from open surgery to small incision surgery and then to arthroscopic surgery. Arthroscopic repair has become the gold standard in the treatment of rotator cuff tears. These changes in surgical approach have also generated interest among clinicians in exploring safe postoperative rehabilitation treatment strategies. Despite the current advances in surgical approaches, the incidence of joint stiffness and non-healing rates after RCR remain high. Joint stiffness is the most common complication after RCR, with a reported incidence of 4.9% to 32.7%.
Non-healing rates after RCR range from 20% to 94%.
to 94%. Factors affecting tendon healing include: age over 65 years, diabetes, osteoporosis, cardiovascular disease, smoking, extent of the tear and long-term nature of the tear. A successful post-operative rehabilitation program should take these factors into account in addition to the trade-off between the risk of complicating joint stiffness and failure of the repair. The debate on postoperative rehabilitation after RCR continues. The main issues debated in the literature are early restriction of joint motion or early active joint motion, the use of a sling, the optimal time to start physical therapy and the appropriate amount of daily activity. There is a prevalence of the idea of delaying the start of joint activity in order to increase the healing rate.
and Pupello have reported that delaying joint activity did not affect patient satisfaction and slightly improved healing rates after RCR.
al also reported that six weeks of inactivity did not result in long-term joint stiffness and perhaps improved tendon healing rates. after comparing patients with early active joint activity and restricted joint activity after surgery, Lee and colleagues concluded that early active activity might increase the risk of rotator cuff retear. Although not yet proven, early joint activity statistically suggests an increased rate of rotator cuff re-injury.