This may be performed either through keyhole surgery arthroscopy or open surgery, using sutures and bone anchors. Pdf early reports on arthroscopic massive rotator cuff repair demonstrated acceptable clinical outcomes with low rates of postoperative cuff. Effectiveness of supervised early exercise program in. Anatomic repair of massive cuff tears is also technically difficult due to scarring, retracted tissue. Three arthroscopic techniques for repairing the rotator cuff. Mark powell if biceps tenodesis is concomitantly performed, no biceps strengthening until 8 weeks postoperative if approved by physician. Before suggesting the operation, your doctor will have considered that the benefits of the procedure outweigh any disadvantages. Arthroscopic rotator cuff repair postoperative guidelines. May remove sling for tabletop activities within pain tolerance such as eating, brushing teeth and occasional keyboard use. Sling with supporting abduction pillow to be worn at all times except for hygiene and therapeutic exercise codmans pendulum exercise, elbowwristhand rom, grip strengthening. The patients in this study treated with arthroscopic decompression alone had less satisfactory results than those who had repair of the cuff. These tears may be the result of an injury you can read our post on acute rotator cuff tears or wear and degeneration read our post on chronic rotator. The sr series graspers feature a selfreleasing lock mechanism that is easily disengaged by simply moving the handles apart.
Allarthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff. Arthroscopic rotator cuff repair guys and st thomas. Right in this image of a rotator cuff tear, a large gap can be seen between the edge of the rotator cuff tendon and the humeral head. The intent of this guideline is to provide both the patient and treating therapist with a framework of the postoperative rehabilitation course following arthroscopic assistedminiopen rotator cuff repair. Left arthroscopic view of a healthy shoulder joint. Arthroscopic subacromial decompression for small and. Arthroscopic rotator cuff repair general sling and abduction pillow for four weeks, then sling without pillow for two more weeks wear at all times while awake and asleep can remove when sitting and hep no active shoulder abduction, flexion or rotation for six weeks for most repairs phase i. Arthroscopic rotator cuff repair physical therapy protocol small tears one anchor phase i. It is important to remember that time frame for healing of the repair does not change based on the method of repair. Rehabilitation guidelines for type i and type ii rotator cuff repair and isolated subscapularis repair the anatomic configuration of the shoulder joint glenohumeral joint is often compared to that of a golf ball on a tee. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the american society of shoulder and elbow therapists.
The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non. Arthroscopic rotator cuff repair physical therapy protocol. A miniopen repair procedure also uses newer technology and instruments to perform a repair through a small incision. Rotator cuff tears are a common cause of shoulder pain and dysfunction in the adult shoulder. Rolf phase i immediate post surgical phase weeks 14. Doublerow ripstop technique for arthroscopic rotator cuff. Rotator cuff repair depends on both the fixation strength of the chosen repair construct and the local healing response of the repaired tissue. Arthroscopic rotator cuff repair resume of scott j. Arthroscopic massive rotator cuff repair and techniques for. Current evidence for effectiveness of interventions to treat rotator cuff tears. To perform arthroscopic rotator cuff repair, your doctor will make three small, buttonhole sized incisions in the area around the shoulder. Arthroscopic rotator cuff repair protocol boston shoulder institute. The rotator cuff tendon needs to heal back into the bone. The reason for this is both pain and the functional demand of the patient.
Prospect guideline for rotator cuff repair surgery. Rotator cuff injury is a common condition that has been reported to affect more than 40% of the us population over 60 years of age. Initiate manual resistance er supine in scapular plane light resistance. A rotator cuff repair involves stitching the torn tendon back onto its attachment to the arm bone humerus. Previous authors have presented open and arthroscopic repair techniques that involve recognition of the tear con.
Arthroscopic rotator cuff repair with concomitant capsular. Arthroscopic rotator cuff repair rehabilitation protocol. Early postoperative outcomes between arthroscopic and mini. Arthroscopic rotator cuff repair florida orthopaedic institute. It is likely that there has already been an attempt at non surgical treatment such as injections or physiotherapy.
Symptoms of rotator cuff injuries people of all ages injure their rotator cuffs. Among a growing discussion surrounding the superiority of one surgical technique over another, the surgeons ability to complete a rotator cuff repair with technical acuity in a timely manner remains paramount. The surgeon can maximize the chance of a healed repair by knowing the endpoint of each key step in the repair process and adhering to a few core principles. The goal of rotator cuff repair is to eliminate pain and improve function with. The treatment of rotator cuff tears in the face of passive glenohumeral motion loss is controversial. Arthroscopic rotator cuff repair technique shoulderdoc. Patients with rotator cuff tears may present with or subsequently develop concomitant shoulder stiffness.
Although the rotator cuff can get injured at the muscletendon junction, most commonly a rotator cuff tear involves tendon fiber detachment off of bone. A healed rotator cuff repair results in a superior outcome for the patient compared with a nonhealed repair. The intent of this protocol is to provide the clinician with a. Open versus two forms of arthroscopic rotator cuff repair ncbi. Advances in mobilization techniques allow rotator cuff repair through use of a single or. The rate limiting factor in arthroscopic rotator cuff repair is the biologic healing of the cuff tendon to the humerus, which is thought to be a minimum of 812 weeks. Arthrex offers many anchor and surgical technique options for surgeons who prefer to tie knots. Patient to do home exercises given postop p endulums, elbow rom, wrist rom, grip strengthening patient to remain in splint for 6 weeks weeks 16. Rotator cuff repair arthroscopic patient education and. The past decade has seen a major change in the way that rotator cuff surgery is performed. Arthroscopic rotator cuff repair is commonly performed and is generally a safe procedure.
This procedure is carried out when a patient has a symptomatic rotator cuff tear. Prior to the development of arthroscopic surgery, all rotator cuff tears were repaired by looking directly at the torn tendon through an incision about 6 to 10 centimeters in length. Arthroscopic rotator cuff repair rehabilitation protocol rom immobilizer therapeutic exercise phase 1 04 weeks no prom. Rotator cuff grasper the rotator cuff grasper features a long shaft and a wide, deep jaw that allows for superior purchase when grasping tissue during rotator cuff surgery. This technical note presents our preferred technique of an allarthroscopic, medialized repair with. Aug 07, 2019 the analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non. Arthroscopic rotator cuff repair protocol sequence note. A total of 118 patients between the ages of 18 and 50 years with arthroscopic rc repair will be randomized to 2 treatment arms. The advantages of repairing a rotator cuff tear arthroscopically keyhole surgery are.
Recent advances in arthroscopic rotator cuff repair have resulted in improved outcomes. Jan 01, 2016 rotator cuff injury is a common condition that has been reported to affect more than 40% of the us population over 60 years of age. Arthroscopic rotator cuff repairs use small incisions versus the larger openings required for the conventional rotator cuff repair, makes this a preferred procedure for patients. Specific changes in the program will be made by the physician as appropriate for an individual patient. The advantage of open rotator cuff repairs is the rotator cuff tendons are easily seen by this method. Independent with adls with modifications while maintaining the integrity of the repair. Sports medicine arthroscopic surgery the intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Repair of the rotator cuff requires reattachment of the rotator cuff tendon back to the humerus. Preoperative shoulder stiffness has been considered by some a contraindication to rotator cuff repair. There are several different arthroscopic techniques that can be used to repair a torn rotator cuff. Progression of arom against gravity and duration of sling use is predicated both on the size of tear and quality of tissue and should be guided by referring physician. Arthroscopic rotator cuff repair protocol small to medium sized tears david j.
Montgomery et pared the results between arthroscopic decompressions without cuff repair to open repairs of the torn rotator cuff. Early incorporation of an evidencebased aquaticassisted. Despite advanced mobilization techniques, arthroscopic repair of massive rotator cuff tears is associated with a high retear rate. This video demonstrates the steps involved in one type of arthroscopic repair. Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. Some surgeons recommend staging surgical procedures and delaying rotator cuff repair. Immediate postoperative days 1 to 10 goals maintain integrity of the repair gradually increase passive range of motion diminish pain and inflammation prevent muscular inhibition days 1 to 6 brace ultrasling with abduction pillow. This can be performed in many different ways ranging from open to all arthroscopic procedures and single or double row repair techniques. Rotator cuff repair is the surgery used to repair a tear in one of these tendons. Avi file repair software avi file audio video interleave also audio video interleaved, known by its acronym avi, is a multimedia container format introduced by microsoft in november 1992 as part of its video for windows technology.
Arthroscopic rotator cuff repair rehabilitation protocol dr. Rotator cuff is the term given to describe a group of four tendons that support and stabilize the shoulder joint. Arthroscopic subacromial decompression for small and medium. Small tear arthroscopic rotator cuff repair postoperative guidelines. Within the active population, no matter the patients age, an active sporting individual with a traumatic rotator cuff tear is an indication for arthroscopic rotator cuff repair. This is an enhanced pdf from the journal of bone and joint surgery. If you have any questions regarding the progress of the patient, the physician should be contacted. Immediate postoperative days 1 to 10 goals maintain integrity of the repair gradually increase passive range of motion diminish pain and inflammation prevent muscular inhibition days 1. The intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. All arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff.
Arthroscopic rotator cuff repair advocate health care. Sports medicinearthroscopic surgery the intent of this protocol is to provide the therapist and patient with guidelines for the postoperative rehabilitation course after arthroscopic rotator cuff repair. Patients that have a rotator cuff repair performed arthroscopically tend to be less painful postoperatively than the patients that have an open repair. However, to make an informed decision and give your.
Arthroscopic repair of the rotator cuff is an increasingly popular method, one for which many authors have reported satisfactory outcomes. Arthroscopic rotator cuff repair frequently asked questions. Rehabilitation guidelines for type i and type ii rotator cuff. Open, miniopen, and allarthroscopic rotator cuff repair. Pdf arthroscopic rotator cuff repair using the undersurface. This is because the articular surface of the round humeral head is approximately four times greater than that of the. Pdf the purpose of this article is to report the 4 to 10year results of arthroscopic repair of full thickness rotator cuff tears. Arthroscopic repair is usually performed as an outpatient procedure and is the least invasive method used to repair a torn rotator cuff. Move into available range, painfree and as tolerated at least 0 90. Our metaanalysis indicated that early motion after arthroscopic rotator cuff repair resulted in a significantly greater recovery of external rotation from preoperation to 3, 6, and 12 months.