Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Am J Sports Med. 2012 Apr;40(4):815-21. doi: 10.1177/0363546511434287. Epub 2012 Jan 27.
Early passive motion exercise has been the standard rehabilitation protocol after rotator cuff repair for preventing postoperative stiffness. However, recent approaches show that longer immobilization may enhance tendon healing and quality.
To elucidate whether early passive motion exercise affects functional outcome and tendon healing after arthroscopic rotator cuff repair.
Randomized controlled trial; Level of evidence, 1.
One hundred five consecutive patients who underwent arthroscopic repair for small to medium-sized full-thickness rotator cuff tears were included. Patients with large to massive tears and concomitant stiffness or labral lesions were excluded. Patients were instructed to wear an abduction brace for 4 to 5 weeks after surgery and to start active-assisted shoulder exercise after brace weaning. Fifty-six patients were randomly allocated into group 1: early passive motion exercises were conducted 3 to 4 times per day during the abduction brace-wearing period. Forty-nine patients were allocated into group 2: no passive motion was allowed during the same period. Range of motion (ROM) and visual analog scale (VAS) for pain were measured preoperatively and 3, 6, and 12 months postoperatively. Functional evaluations, including Constant score, Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) score, were also evaluated at 6 and 12 months postoperatively. Ultrasonography, magnetic resonance imaging, or computed tomography arthrography was utilized to evaluate postoperative cuff healing.
There were no statistical differences between the 2 groups in ROM or VAS for pain at each time point. Functional evaluations were not statistically different between the 2 groups either. The final functional scores assessed at 12 months for groups 1 and 2 were as follows: Constant score, 69.81 ± 3.43 versus 69.83 ± 6.24 (P = .854); SST, 9.00 ± 2.12 versus 9.00 ± 2.59 (P = .631); and ASES score, 73.29 ± 18.48 versus 82.90 ± 12.35 (P = .216). Detachment of the repaired cuff was identified in 12% of group 1 and 18% of group 2 (P = .429).
Early passive motion exercise after arthroscopic cuff repair did not guarantee early gain of ROM or pain relief but also did not negatively affect cuff healing. We suggest that early passive motion exercise is not mandatory after arthroscopic repair of small to medium-sized full-thickness rotator cuff tears, and postoperative rehabilitation can be modified to ensure patient compliance.
早期被动运动一直是肩袖修补术后预防术后僵硬的标准康复方案。然而，最近的研究表明，较长时间的固定可能会增强肌腱愈合和质量。
阐明关节镜肩袖修复后早期被动运动是否会影响功能结果和肌腱愈合。
随机对照试验；证据水平，1 级。
纳入 105 例接受关节镜下修复小至中等大小全层肩袖撕裂的连续患者。排除大到巨大撕裂以及伴有僵硬或盂唇损伤的患者。术后指导患者佩戴肩外展支具 4 至 5 周，并在支具脱落后开始主动辅助肩部运动。56 例患者随机分为 1 组：在佩戴支具期间，每天进行 3 至 4 次被动运动。49 例患者被分配到 2 组：同一时期不允许进行被动运动。术前及术后 3、6 和 12 个月测量关节活动度（ROM）和疼痛视觉模拟量表（VAS）。术后 6 和 12 个月还进行了包括 Constant 评分、简单肩部测试（SST）和美国肩肘外科医生（ASES）评分在内的功能评估。超声、磁共振成像或计算机断层扫描关节造影术用于评估术后肩袖愈合情况。
两组患者在每个时间点的 ROM 或疼痛 VAS 均无统计学差异。两组患者的功能评估也无统计学差异。第 1 组和第 2 组的最终功能评分在 12 个月时分别为：Constant 评分，69.81±3.43 对 69.83±6.24（P=0.854）；SST，9.00±2.12 对 9.00±2.59（P=0.631）；ASES 评分，73.29±18.48 对 82.90±12.35（P=0.216）。第 1 组有 12%的患者和第 2 组有 18%的患者肩袖修复处有分离（P=0.429）。
关节镜肩袖修复后早期被动运动并不能保证早期获得 ROM 或缓解疼痛，也不会对肩袖愈合产生负面影响。我们认为，对于小至中等大小全层肩袖撕裂的关节镜修复后，早期被动运动不是必需的，术后康复可以进行修改以确保患者的依从性。
