Artroskopik rotator manşet onarımı sonrasında uygulanan yavaş ve hızlı rehabilitasyon protokollerinin eklem hareket açıklığı üzerindeki etkileri

Year 2014, Volume: 48 Issue: 6, 642 - 648, 16.01.2015

Irem Duzgun Gul Baltaci Elif Turgut O. Ahmet Atay

https://doi.org/10.3944/AOTT.2014.13.0125

Abstract

 

Amaç: Bu çalışmadaki amacımız artroskopik rotator manşet onarımı sonrası erken başlanan pasif ve aktif eklem hareketinin erken dönemdeki etkilerini araştırmaktı.

Çalışma planı: Çalışmaya artroskopik rotator manşet onarımı geçirmiş 40 hasta katıldı. Hastalar yarı-rastgele yöntemle hızlandırılmış (HIZLI) protokol grubu (n=19) ve yavaş (YAVAŞ) protokol grubuna (n=21) ayrıldılar. Her iki gruptaki hastalara aynı tedavi protokolü uygulandı. HIZLI grubunda 3. haftada, YAVAŞ grubunda ise 6. haftada aktif eklem hareketine başlandı. Eklem hareketi cerrahi sonrası 3, 5, 8, 12 ve 24. haftalarda kaydedildi.

Bulgular: Aktif eklem hareketinin haftalar içinde giderek arttığı izlenirken, protokoller arasında bir fark görülmedi. Sadece, HIZLI grubunda aktif total elevasyonun tüm değerlendirme noktalarındaki ölçümlerde daha fazla olduğu saptandı (p<0.05).

Çıkarımlar: Artroskopik rotator manşet onarımı sonrası yapılan pasif ve nazik ve kontrollü aktif eklem hareketlerinin cerrahi sonrası 6. ayda eklem hareketi üzerine bir etkisinin olmadığı gözükmektedir.

Keywords

Egzersiz; manuel terapi; rehabilitasyon; rotator manşet.

Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair

Abstract

Objective: The aim of the study was to investigate the effects of the early initiation of passive and active range of motion exercises following arthroscopic rotator cuff repair.

Methods: The study included 40 patients who underwent arthroscopic rotator cuff repair. Patients were quasi-randomly assigned into accelerated (ACCEL) protocol (n=19) and slow (SLOW) protocol (n=21) groups. Patients in both groups were treated with the same protocol. Active range of motion was begun at the 3rd week in the ACCEL group and the 6th week in the SLOW group. Range of motion was recorded at postoperative weeks 3, 5, 8, 12, and 24.

Results: While active range of motion for all measurements improved across weeks, there were no differences between groups, with the exception of active total elevation which was greater at all time point measurements in the ACCEL group (p<0.05).

Conclusion: The early initiation of passive and gentle controlled active motion exercise following rotator cuff repairs does not appear to affect range of motion in the first 6 postoperative months.

Keywords

Exercise, manual therapy, rehabilitation, rotator cuf

References

• Gartsman GM. Arthroscopic management of rotator cuff disease. J Am Acad Orthop Surg 1998;6:259-66.
• Lastayo PC, Wright T, Jaffe R, Hartzel J. Continuous pas- sive motion after repair of the rotator cuff. A prospective outcome study. J Bone Joint Surg Am 1998;80:1002-11.
• Kannus P, Jozsa L, Kvist M, Lehto M, Järvinen M. The effect of immobilization on myotendinous junction: an ultrastructural, histochemical and immunohistochemical study. Acta Physiol Scand 1992;144:387-94. CrossRef
• Gimbel JA, Van Kleunen JP, Williams GR, Thomopoulos S, Soslowsky LJ. Long durations of immobilization in the rat result in enhanced mechanical properties of the heal- ing supraspinatus tendon insertion site. J Biomech Eng 2007;129:400-4. CrossRef
• Peltz CD, Dourte LM, Kuntz AF, Sarver JJ, Kim SY, Wil- liams GR, et al. The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg Am 2009;91:2421-9. CrossRef
• Sarver JJ, Peltz CD, Dourte L, Reddy S, Williams GR, So- slowsky LJ. After rotator cuff repair, stiffness--but not the loss in range of motion--increased transiently for immo- bilized shoulders in a rat model. J Shoulder Elbow Surg 2008;17(1 Suppl):108S-113S. CrossRef
• Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 2001;83-A:71-7.
• Cohen BS, Romeo AA, Bach B Jr. Rehabilitation of the shoulder and rotator cuff repair. Oper Tech Orthop 2002;12:218-24. CrossRef
• Wilkes JS. Rotator Cuff Repairs. In: Donatelli RA, editor. Physical Therapy of The Shoulder, 4th edition. St. Louis, MO: Churchill Livingstone; 2004. p. 505-16. CrossRef
• Klintberg IH, Gunnarsson AC, Svantesson U, Styf J, Karlsson J. Early loading in physiotherapy treatment after full-thickness rotator cuff repair: a prospective random- ized pilot-study with a two-year follow-up. Clin Rehabil 2009;23:622-38. CrossRef
• Düzgün I, Baltacı G, Atay OA. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rota- tor cuff repair: pain and functional activity. Acta Orthop Traumatol Turc 2011;45:23-33. CrossRef
• Hayes K, Walton JR, Szomor ZR, Murrell GA. Reliabil- ity of five methods for assessing shoulder range of motion. Aust J Physiother 2001;47:289-94. CrossRef
• Constant CR, Gerber C, Emery RJ, Sİjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifica- tions and guidelines for its use. J Shoulder Elbow Surg 2008;17:355-61. CrossRef
• Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med 2005;33:1751-67. CrossRef
• Henriksson M, Rockborn P, Good L. Range of motion training in brace vs. plaster immobilization after anterior cruciate ligament reconstruction: a prospective random- ized comparison with a 2-year follow-up. Scand J Med Sci Sports 2002;12:73-80. CrossRef
• Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 2006;15:290-9. CrossRef
• Braune C, von Eisenhart-Rothe R, Welsch F, Teufel M, Jaeger A. Mid-term results and quantitative comparison of postoperative shoulder function in traumatic and non- traumatic rotator cuff tears. Arch Orthop Trauma Surg 2003;123:419-24. CrossRef
• Fehringer EV, Sun J, VanOeveren LS, Keller BK, Mat- sen FA 3rd. Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in pa- tients sixty-five years and older. J Shoulder Elbow Surg 2008;17:881-5. CrossRef
• Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 1998;80:832-40.
• Habernek H, Schmid L, Frauenschuh E. Five year results of rotator cuff repair. Br J Sports Med 1999;33:430-3.
• Lee E, Bishop JY, Braman JP, Langford J, Gelber J, Fla- tow EL. Outcomes after arthroscopic rotator cuff repairs. J Shoulder Elbow Surg 2007;16:1-5. CrossRef
• Murray TF Jr, Lajtai G, Mileski RM, Snyder SJ. Ar- throscopic repair of medium to large full-thickness rotator cuff tears: outcome at 2- to 6-year follow-up. J Shoulder Elbow Surg 2002;11:19-24. CrossRef
• Grondel RJ, Savoie FH 3rd, Field LD. Rotator cuff repairs in patients 62 years of age or older. J Shoulder Elbow Surg 2001;10:97-9. CrossRef
• Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Aust J Physiother 2004;50:77-83. CrossRef
• Boissonnault WG, Badke MB, Wooden MJ, Ekedahl S, Fly K. Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comor- bidities. J Orthop Sports Phys Ther 2007;37:312-9.
• Kovacevic D, Rodeo SA. Biological augmentation
• of rotator cuff tendon repair. Clin Orthop Relat Res 2008;466:622-33. CrossRef
• Thomopoulos S, Williams GR, Soslowsky LJ. Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng 2003;125:106-13. CrossRef
• Koh KH, Lim TK, Shon MS, Park YE, Lee SW, Yoo JC. Effect of immobilization without passive exercise after ro- tator cuff repair: randomized clinical trial comparing four and eight weeks of immobilization. J Bone Joint Surg Am 2014;96:e44. CrossRef
• Arnold F, West DC. Angiogenesis in wound healing. Pharmacol Ther 1991;52:407-22. CrossRef
• Harris JD, Ravindra A, Jones GL, Butler RB, Bishop JY. Setting patients’ expectations for range of motion after ar- throscopic rotator cuff repair. Orthopedics 2013;36:e172-8.
• Galatz LM, Ball CM, Teefey SA, Middleton WD, Yama- guchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86-A:219-24.