Background

As orthopedic surgeons we recognize that not every rotator cuff tear is the same.  Every patient is different. The size and age of the rotator cuff tear, the duration of the symptoms, the age of the patient, the presence of diabetes, the use of tobacco products, the presence of atrophy or weakness of the shoulder muscles can all influence the potential success and outcome of rotator cuff surgery.  We do our best to identify those risks factors for a successful outcome based on the patient’s history, examination and imaging studies including plain x-ray and MRI. We also try to predict when patients would be able to return to normal life and work related activities after rotator cuff repair.

Purpose

A recent study looked at the functional recovery of daily activities for specific movements after arthroscopic rotator cuff repair.  These authors looked at to answer several questions.

After arthroscopic rotator cuff repair, when are patients able to perform low level and high level front of body motion, low level at high level behind the back motion, strength-related activities, and sports and leisure activities?  They also looked at how the size of the rotator cuff tear, arm dominance and re-tear affect the performance of these activities.

Study Design

This was a prospective study over 2-years.  They followed 135 patients. 45 patients had a small sized rotator cuff tear, 45 patients had a medium-sized rotator cuff tear and 45 patients had a large to massive rotator cuff tear.  The mean age of the patient was 60 years.

Methods

31 of the tears occurred in the nondominant shoulder and 104 of the rotator cuff tears occurred in the dominant shoulder.  27 of the 145 patients showed a re-tear on the MRI at 9 months after surgery. They used a UCLA scoring mechanism to determine their outcomes.  Patient’s filled out a questionnaire at 1, 2, 3, 6, 9, 12, 15, 18 and 24 months after surgery.

  • Patients recovered a low level range of motion at about 2 ± 1 months after surgery.
  • They recovered a high level range of motion in front of the body at 3 ± 2 months following surgery.
  • A high level range of motion behind the back was recovered at 9 ± 0 months after surgery.
  • Simple strength related activities recovered on an average of 10 ± 2 months after surgery.
  • Sports and leisure related activities recovered within 14 ± 3 months after surgery.

Results

2 of the 45 patients with large to massive rotator cuff tears did not gain recovery of high level range of motion behind the back, simple strength related in sports or leisure related activities.

Patients with large tears were delayed from some activities compared to patients with small tears with respect to washing their back, behind her back activities, lifting or sports and leisure activity.

Arm dominance was not associated with functional recovery.  Patients with recurrent tears compared to patients who had an intact rotator cuff repair, had a longer time to return to washing her hair, combing, washing their back and sports and leisure related activities.

Conclusion

In conclusion, it took these patients an average of 14 months to recover the daily motion after surgery.  The size of the rotator cuff tear and a re-tearing of the rotator cuff affected only the recovery of high level motion activities and sports and leisure related activities.

When Do Patients Return to Previous Daily Activity After Arthroscopic Rotator Cuff Repair? Clin Orthop Related Res. 2019 Feb;477(2):403-413. Kim HJ1, Kim JY, Rhee YG.

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