Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Department of Orthopaedic Surgery, Carilion Clinic Institute for Orthopaedics and Neurosciences, Roanoke, Virginia.
J Bone Joint Surg Am. 2022 Sep 21;104(18):1639-1648. doi: 10.2106/JBJS.21.01436. Epub 2022 Jul 21.
Evidence-based guidelines are lacking for return to driving following rotator cuff repair (RCR). As a result, surgeons are often overly conservative in their recommendations, placing potential undue burden on patients and their families. Therefore, the primary objective of this study was to formulate evidence-based return-to-driving guidelines.
Thirty-two subjects planning to undergo primary RCR were enrolled. Driving fitness was assessed in a naturalistic setting with an instrumented vehicle on public streets with a safety monitor onboard. Driving kinematic measures and behavioral data were obtained from vehicle data and camera capture. Several driving tasks and maneuvers were evaluated, including parking, left and right turns, straightaways, yielding, highway merges, and U-turns. The total course length was 15 miles (24 km) and the course took 45 to 55 minutes to complete. The subjects' baseline drive was performed prior to RCR and postoperative drives occurred at 2, 4, 6, and 12 weeks after RCR. All drives consisted of identical routes, tasks, and maneuvers. Driving metrics were analyzed for differences between baseline and postoperative drives, including differences in gravitational force equivalents (g).
Twenty-seven subjects (mean age, 58.6 years [range, 43 to 68 years]) completed all 5 drives. Of the 13 analyzed kinematic metrics measured from 14 of 17 driving events, all exhibited noninferiority across all postoperative drives (2 to 12 weeks) after RCR compared with baseline. Beginning at postoperative week 2, subjects generally braked less aggressively, steered more smoothly, and drove more stably. Kinematic metrics during the performance of specific maneuver types also showed noninferiority when compared with baseline. Of note, subjects drove more smoothly on highway merges starting at postoperative week 2 (minimum longitudinal acceleration, -0.35 g [95% confidence interval (CI), -0.050 to -0.019 g]; standard deviation of longitudinal acceleration, 0.008 g [95% CI, 0.003 to 0.013 g]), but exhibited more aggressive driving and acceleration on highway merges at postoperative week 12 (maximum absolute yaw, -0.8°/sec [95% CI, -1.2°/sec to -0.4°/sec]).
Patients showed no clinically important negative impact on driving fitness as early as 2 weeks after RCR. Adaptive behaviors were present both preoperatively and postoperatively.
Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
目前缺乏关于肩袖修复（RCR）后恢复驾驶的循证指南。因此，外科医生在其建议中往往过于保守，给患者及其家属带来不必要的负担。因此，本研究的主要目的是制定循证驾驶指南。
招募了 32 名计划行初次 RCR 的受试者。在自然环境中，使用安装在公共街道上的仪器化车辆和车载安全监视器来评估驾驶适应性。从车辆数据和摄像机捕获中获得驾驶运动学测量值和行为数据。评估了多项驾驶任务和操作，包括停车、左右转弯、直线行驶、避让、高速公路合流和掉头。总路程为 15 英里（24 公里），完成整个过程需要 45 到 55 分钟。在 RCR 之前进行基线驾驶，术后在 RCR 后 2、4、6 和 12 周进行驾驶。所有驾驶都包括相同的路线、任务和操作。分析了基线和术后驾驶之间的驾驶指标差异，包括重力等效值（g）的差异。
27 名受试者（平均年龄 58.6 岁[范围 43 至 68 岁]）完成了所有 5 次驾驶。在 17 次驾驶事件中的 14 次中测量的 13 个分析运动学指标中，所有指标在 RCR 后 2 至 12 周的所有术后驾驶中均表现出非劣效性。从术后第 2 周开始，受试者的制动力度普遍减弱，转向更平稳，行驶更稳定。在执行特定操作类型时的运动学指标与基线相比也表现出非劣效性。值得注意的是，受试者在术后第 2 周开始在高速公路合流时行驶得更平稳（最小纵向加速度，-0.35g[95%置信区间（CI），-0.050 至-0.019g]；纵向加速度标准差，0.008g[95%CI，0.003 至 0.013g]），但在术后第 12 周的高速公路合流时驾驶和加速更具侵略性（最大绝对偏航，-0.8°/sec[95%CI，-1.2°/sec 至-0.4°/sec]）。
RCR 后最早 2 周患者的驾驶适应性无明显临床负面影响。术前和术后均存在适应性行为。
预后 II 级。有关证据水平的完整描述，请参阅作者说明。
