Posts

Home based unsupervised rehabilitation protocol following rotator cuff repair has good outcomes: A prospective study

Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  July-Dec 2021 | page:12-15 | Rohan A Habbu


Author: Rohan A Habbu

[1] Department of Upper Limb Surgery, Prime Health Clinic Ground floor, Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India

Address of Correspondence
Dr. Rohan A Habbu,
Department of Upper Limb Surgery, Prime Health Clinic Ground floor,
Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India
E-mail: dr_habbu@yahoo.com


Abstract

Background: Rehabilitation after rotator cuff repair achieves good results but it involves time and costs. A simple home based program will reduce costs, time to travel and chance of exposure in a pandemic scenario. The objective of the study was to assess outcomes of home based rehabilitation protocol following rotator cuff repair.
Methods: This was a prospective study of 42 patients who underwent rotator cuff repair followed by an unsupervised home based rehabilitation protocol. The tears were identified using clinical examination and Magnetic Resonance Imaging. The cuff repair was done with mini open incision technique. The patients were taught an exercise protocol, which they did by themselves at home. There was no daily supervision by the treating surgeon or a physiotherapist. The study measured pain scores, return to work, range of motion and failures at one year.
Results: Mean duration of followup was 14 months. Visual Analogue Score for pain improved from preoperative mean 7.5 to followup mean 1.3. Disability of the Arm, Hand and Shoulder score, measured in 26 patients improved from preoperative mean 33.2 to followup mean 4.5. Range of motion improved in 39 patients. Cuff strength was normal in 39 patients. 37 patients returned to full work by three months. There were three failures with one patient developing significant stiffness and two patients showing a retear. The retear was seen in patients with large retracted tears and the repair was done under tension.
Conclusion: Home based exercise protocol for postoperative rehabilitation in rotator cuff repairs can achieve good results in carefully selected patients. The study does not recommend this for large tears with difficult repairs. Since the patients are doing the postoperative rehabilitation at home, this reduces the costs, time lost in travel and exposure to external factors.
Keywords: Rotator cuff, mini open repair, unsupervised rehabilitation, motion


References

1. Beaudreuil J, Dhénain M, Coudane H, Mlika-Cabanne N. Clinical practice guidelines for the surgical management of rotator cuff tears in adults. Orthopaedics & Traumatology: Surgery & Research 2010; 96: 175–179.
2. Huisstede BM, Koes BW, Gebremariam L, Keijsers E, Verhaar JA. Current evidence for effectiveness of interventions to treat rotator cuff tears. Manual therapy 2011; 16: 217–230.
3. Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Aust J Physiother 2004;50:77-83.
4. Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF. A randomized controlled trial comparing 2 instructional
approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther 2002; 32: 548-559.
5. Büker NA, Akkaya S, Akkaya N. Comparison of the results of supervised physiotherapy program and home-based exercise program in patients treated with arthroscopic-assisted miniopen rotator cuff repair. Eklem Hastalik Cerrahisi 2011; 22(3):134-139.
6. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy 2012; 28(1): 34-42.
7. Baumgarten KM, Vidal AF, Wright RW. Rotator cuff rehabilitation. A level 1 and level 2 systematic review. Sports Health 2009;1(2):125-130.
8. Holmgren T, Oberg B, Sjöberg I, Johansson K. Supervised strengthening exercises versus home-based movement
exercises after arthroscopic acromioplasty: a randomized clinical trial. J Rehabil Med 2012; 44(1): 12-18.
9. Andersen NH, Sojbjerg JO, Johannsen HV, Sneppen O. Selftraining versus physiotherapist-supervised rehabilitation of the shoulder in pa- tients treated with arthroscopic subacromial decompression: a clinical randomized study. J Shoulder Elbow Surg 1999; 8: 99–101.
10. Lisinski P, Huber J, Wilkosz P, Witkowska A, Wytrazek M,Samborski W et al. Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study. Int. J Artif Organs 2012;35: 45–54.
11. Longo UG, Berton A, Ambrogioni LR, Lo Presti D, Carnevale A, Candela V et al. Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis. Int J Environ Res
Public Health 2020;17:2852.
12. Song SJ, Jeong TH, Moon JW, Park HV, Lee SY, Koh KH. Short-term Comparison of Supervised Rehabilitation and
Home- based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair. Clinics in Shoulder and Elbow 2018; 21(1): 15-21.
13. Gallagher BP, Bishop ME, Tjoumakaris FP, Freedman KB. Early versus delayed rehabilitation following arthroscopic
rotator cuff repair: A systematic review. Phys Sportsmed 2015;43(2): 178-187.

How to Cite this article: Habbu RA. Home based unsupervised rehabilitation protocol following rotator
cuff repair has good outcomes: A prospective study. Journal of Clinical Orthopaedics July-Dec 2021;6(2):12-15.

 (Abstract    Full Text HTML)   (Download PDF)


History and Future Direction of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Vol 3 | Issue 2 |  July-Dec 2018 | Page 12-15 | Teruhisa Mihata.


Authors: Teruhisa Mihata [1,2,3].

[1] Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
[2] Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
[3] Katsuragi Hospital, Kishiwada, Osaka, Japan

Address of Correspondence
Dr. TeruhisaMihata,
Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
Email: tmihata@yahoo.co.jp, tmihata@osaka-med.ac.jp


Abstract

Lesions of the superior shoulder capsule had been a neglected entity before I reported my technique for superior capsule reconstruction (SCR).I had noticed that patients with irreparable rotator cuff tears always had irreparable defects of the superior shoulder capsule as well as the rotator cuff tendons, because the superior shoulder capsule is attached to the undersurface of these tendons. Therefore, I hypothesized that reconstruction of the superior shoulder capsule might be useful to prevent superior migration of the humeral head and subacromial impingement in irreparable rotator cuff tears. To prove my hypothesis, our group performed a cadaveric biomechanical study in 2005. This biomechanical study showed that SCR completely restored superior stability of the glenohumeral joint, whereas patch grafting to the supraspinatus tendon (conventional patch graft surgery) only partially restored superior translation to the intact level. Consequently, in 2007,we started arthroscopic SCR for patients with irreparable rotator cuff tears. From our 10 years of experience with SCR, we conclude that arthroscopic SCR restores superior glenohumeral stability and improves shoulder function in irreparable rotator cuff tears.
Keywords: Irreparable, Reconstruction, Rotator Cuff, Shoulder, Superior capsule


References

1. Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am 2010;92:1894-1908.
2. Oh JH, Kim SH, Kang JY, Oh CH, Gong HS. Effect of age on functional and structural outcome after rotator cuff repair. Am J Sports Med 2010;38:672-678.
3. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;78-83.
4. Melis B, Wall B, Walch G. Natural history of infraspinatus fatty infiltration in rotator cuff tears. J Shoulder Elbow Surg 2010;19:757-763.
5. Melis B, Nemoz C, Walch G. Muscle fatty infiltration in rotator cuff tears: descriptive analysis of 1688 cases. Orthop Traumatol Surg Res 2009;95:319-324.
6. Oh JH, Kim SH, Choi JA, Kim Y, Oh CH. Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res 2010;468:1558-1564.
7. Burkhart SS. Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am 1993;24:111-123.
8. Rockwood CA, Jr., Williams GR, Jr., Burkhead WZ, Jr. Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 1995;77:857-866.
9. Burkhart SS. Fluoroscopic comparison of kinematic patterns in massive rotator cuff tears. A suspension bridge model. Clin Orthop Relat Res 1992;144-152.
10. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy 1994;10:363-370.
11. Duralde XA, Bair B. Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 2005;14:121-127.
12. Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet 1982;154:667-672.
13. Karas SE, Giachello TL. Subscapularis transfer for reconstruction of massive tears of the rotator cuff. J Bone Joint Surg Am 1996;78:239-245.
14. Celli L, Rovesta C, Marongiu MC, Manzieri S. Transplantation of teres major muscle for infraspinatus muscle in irreparable rotator cuff tears. J Shoulder Elbow Surg 1998;7:485-490.
15. Debeyre J, Patie D, Elmelik E. Repair of Ruptures of the Rotator Cuff of the Shoulder. J Bone Joint Surg Br 1965;47:36-42.
16. Dierickx C, Vanhoof H. Massive rotator cuff tears treated by a deltoid muscular inlay flap. Acta Orthop Belg 1994;60:94-100.
17. Gerber C. Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res 1992;152-160.
18. Warner JJ, Parsons IMt. Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 2001;10:514-521.
19. Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am 2006;88:113-120.
20. Jost B, Puskas GJ, Lustenberger A, Gerber C. Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am 2003;85-A:1944-1951.
21. Nasca RJ. The use of freeze-dried allografts in the management of global rotator cuff tears. Clin Orthop Relat Res 1988;218-226.
22. Neviaser JS, Neviaser RJ, Neviaser TJ. The repair of chronic massive ruptures of the rotator cuff of the shoulder by use of a freeze-dried rotator cuff. J Bone Joint Surg Am 1978;60:681-684.
23. Heikel HV. Rupture of the rotator cuff of the shoulder. Experiences of surgical treatment. Acta Orthop Scand 1968;39:477-492.
24. Ozaki J, Fujimoto S, Masuhara K, Tamai S, Yoshimoto S. Reconstruction of chronic massive rotator cuff tears with synthetic materials. Clin Orthop Relat Res 1986;173-183.
25. Post M. Rotator cuff repair with carbon filament. A preliminary report of five cases. Clin Orthop Relat Res 1985;154-158.
26. Klein SM, Dunning P, Mulieri P, Pupello D, Downes K, Frankle MA. Effects of acquired glenoid bone defects on surgical technique and clinical outcomes in reverse shoulder arthroplasty. J Bone Joint Surg Am 2010;92:1144-1154.
27. Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop 2010;34:1075-1082.
28. Simovitch RW, Zumstein MA, Lohri E, Helmy N, Gerber C. Predictors of scapular notching in patients managed with the Delta III reverse total shoulder replacement. J Bone Joint Surg Am 2007;89:588-600.
29. Tan SHS, Huh LBP, Krishna L. Outcomes of Anterior Cruciate Ligament Reconstruction in Females Using Patellar-Tendon-Bone versus Hamstring Autografts: A Systematic Review and Meta-Analysis. J Knee Surg 2018.
30. Chin BZ, Wee IJY, Syn NL, Krishna L. Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-Analysis Comparing Semitendinosus Alone and Semitendinosus with Gracilis Tendon Autografts. J Knee Surg 2018.
31. Osti M, El Attal R, Doskar W, Hock P, Smekal V. High complication rate following dynamic intraligamentary stabilization for primary repair of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2018.
32. Neviaser RJ. Tears of the rotator cuff. Orthop Clin North Am 1980;11:295-306.
33. Moore DR, Cain EL, Schwartz ML, Clancy WG, Jr. Allograft reconstruction for massive, irreparable rotator cuff tears. Am J Sports Med 2006;34:392-396.
34. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S. Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 2004;13:538-541.
35. Soler JA, Gidwani S, Curtis MJ. Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases. Acta Orthop Belg 2007;73:432-436.
36. Nimura A, Kato A, Yamaguchi K, et al. The superior capsule of the shoulder joint complements the insertion of the rotator cuff. J Shoulder Elbow Surg 2012;21:867-872.
37. Ishihara Y, Mihata T, Tamboli M, et al. Role of the superior shoulder capsule in passive stability of the glenohumeral joint. J Shoulder Elbow Surg 2014;23:642-648.
38. Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med 2012;40:2248-2255.


How to Cite this article: Mihata T. History and Future Direction of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):12-15.

(Abstract    Full Text HTML)      (Download PDF)