Department of Sports Medicine, Huashan Hospital, Fudan University, No. 12, Wulumuqi Zhong Road, Shanghai 200040, China.
Am J Sports Med. 2013 Aug;41(8):1885-92. doi: 10.1177/0363546513493251. Epub 2013 Jul 11.
Postoperative passive motion is the most widely accepted rehabilitation protocol after rotator cuff repair; however, a rotator cuff retear remains a frequent surgical complication. Clinical outcomes indicate that early passive motion is harmless to rotator cuff healing, but no laboratory evidence supports this proposition.
(1) Immediate postoperative immobilization improves rotator cuff healing in rabbits. (2) Early passive motion after short-term immobilization does not harm rotator cuff healing in rabbits.
Controlled laboratory study.
An injury to the supraspinatus tendon was created and repaired in 90 New Zealand White rabbits, after which they were randomly separated into 3 groups: (1) nonimmobilization (NI; n = 30), (2) continuous immobilization (IM; n = 30), and (3) immobilization with early passive motion (IP; n = 30). At 3, 6, and 12 weeks postoperatively, 5 rabbits from each group were sacrificed for histological evaluation, biomechanical testing, and magnetic resonance imaging.
The histological study demonstrated better postoperative healing in the IM and IP groups, with clusters of chondrocytes accumulated at the tendon-bone junction. Magnetic resonance imaging illustrated that the tendon-bone junction was intact in the IM and IP groups. The magnetic resonance quantification analysis showed that the signal-to-noise quotient (SNQ) of the NI group was not significantly higher than that of the immobilization groups at 3 weeks (P = .232) or 6 weeks (P = .117), but it was significantly different at 12 weeks (NI vs IM, P = .006; NI vs IP, P = .009). At 12 weeks, the failure load was significantly higher in the IM and IP groups than in the NI group (NI vs IM, P = .002; NI vs IP, P = .002), but no difference was found between the IM and IP groups (P = .599).
Immediate postoperative immobilization led to better tendon-bone healing than immediate postoperative mobilization, and under immobilization, early passive motion was harmless to tendon-bone healing in this study.
The results have an implication in supporting the rehabilitation protocol of early passive motion after rotator cuff repair.
术后被动运动是肩袖修复后最广泛接受的康复方案；然而，肩袖再撕裂仍然是一种常见的手术并发症。临床结果表明，早期被动运动对肩袖愈合无害，但没有实验室证据支持这一观点。
（1）术后即刻固定可改善兔肩袖愈合。（2）短期固定后早期被动运动不会损害兔肩袖愈合。
对照实验室研究。
在 90 只新西兰白兔的冈上肌腱处造成损伤并进行修复，然后将其随机分为 3 组：（1）非固定组（NI；n = 30），（2）持续固定组（IM；n = 30）和（3）固定伴早期被动运动组（IP；n = 30）。术后 3、6 和 12 周，每组各有 5 只兔子被处死进行组织学评估、生物力学测试和磁共振成像。
组织学研究表明，IM 和 IP 组的术后愈合更好，在肌腱-骨交界处聚集了软骨细胞簇。磁共振成像显示 IM 和 IP 组的肌腱-骨交界处完整。磁共振定量分析显示，NI 组的信噪比（SNQ）在 3 周（P =.232）和 6 周（P =.117）时均不比固定组高，但在 12 周时明显高于固定组（NI 与 IM，P =.006；NI 与 IP，P =.009）。在 12 周时，IM 和 IP 组的失效负荷明显高于 NI 组（NI 与 IM，P =.002；NI 与 IP，P =.002），但 IM 和 IP 组之间无差异（P =.599）。
术后即刻固定导致的肌腱-骨愈合优于术后即刻活动，在固定状态下，早期被动运动对本研究中的肌腱-骨愈合无害。
研究结果支持肩袖修复后早期被动运动的康复方案。
