Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

PURPOSE: To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair. METHODS: A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor. At 6, 12, and 24 months, strength was reassessed. At 12 months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. RESULTS: The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24 months. At 6 weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24 months, there were no group differences in ROM after 6 weeks (P > .08), and pain (P > .06), strength (P = .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). CONCLUSIONS: EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12 months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6 weeks following arthroscopic RC repair. LEVEL OF EVIDENCE: Level I, high-quality randomized controlled trial.

An evaluation of the responsiveness and discriminant validity of shoulder questionnaires among patients receiving surgical correction of shoulder instability.

Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age = 26.00 ± 8.19 years) undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES), Constant score) preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1) a major recurrence of instability, (2) a single episode of subluxation, (3) any postoperative episode of instability. Eight (20%) patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P < 0.001) and 12-month (P = 0.011) evaluations. The ASES showed improvement at 6 months (P = 0.003), while the Constant score did not report significant improvement until 12 months postoperatively (P = 0.001). Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID). Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair.

Functional Outcomes and Health-Related Quality of Life After Surgical Repair of Full-Thickness Rotator Cuff Tears Using a Mini-Open Technique: A Concise 10-Year Follow-up of a Previous Report.

BACKGROUND: Although good short-term and midterm outcomes are reported for mini-open rotator cuff repair, few prospective studies have investigated long-term results. HYPOTHESIS: Function and health-related quality of life (HRQL) outcomes would be maintained 10 years after mini-open rotator cuff repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients with a confirmed full-thickness rotator cuff tear who underwent mini-open repair between April 1997 and July 2000 were evaluated preoperatively as well as 1 year and 10 years postoperatively for (1) pain, function, and HRQL using the American Shoulder and Elbow Surgeons (ASES) score and Western Ontario Rotator Cuff Index (WORC) score; (2) active shoulder range of motion (ROM) using goniometry; and (3) satisfaction by an independent evaluator. Changes in function, HRQL, and ROM over time were analyzed using repeated-measures analysis of variance. RESULTS: A total of 84 patients were enrolled, of which 61 (73%) were men; the mean (±SD) age was 53.0 ± 9.9 years. At 10 years, 4 (5%) patients were deceased, and 4 (5%) had symptomatic retears. Fifty-nine (74%) patients were evaluated, composed of 43 (73%) men; 26 (44%) were younger than 60 years. Function and HRQL significantly improved over the course of follow-up (P < .001), primarily within the first postoperative year. At 10 years, the mean ASES score was 90.4 ± 19.4, similar to the 1-year score of 91.1 ± 12.0 (P = .83). The mean WORC score at 10 years was 88.7 ± 17.8, with no change from the 1-year score of 88.4 ± 13.6 (P = .93). This relationship did not change after adjusting for age and tear size. Shoulder ROM was also maintained over 10 years. Flexion ROM improved in the first postoperative year, and this improvement was sustained at 10 years after surgery (P ≥ .30). External rotation ROM was slower to improve postoperatively, and significant improvements were seen between 1 and 10 years (P < .01). Fifty-three patients (90%) were satisfied or very satisfied with their results. Tear size, workers' compensation board claimant status, sex, and smoking status did not influence HRQL or shoulder ROM (P > .06). CONCLUSION: Postoperative improvements in function and HRQL after mini-open rotator cuff repair were retained at 10 years.