Artroskopik Rotator Manşet Onarımı Sonrası Rehabilitasyon Programlarının Zamanlama Açısından Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, artroskopik rotator manşet onarımını (RMO) takiben hastalarda erken ve ertelemeli pasif eklem rehabilitasyon protokolünün fonksiyonel sonuçlar ve yaşam kalitesi üzerindeki etkilerini belirlemek ve karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya artroskopik RMO uygulanan toplam 202 hasta dahil edildi. Artroskopik RMO'dan hemen sonra rehabilitasyon programına başlayan 98 hasta erken rehabilitasyon (early rehabilitation, ER), ameliyat sonrası 3 hafta omuz eklem hareketine izin verilmeyen 104 hasta ise gecikmiş rehabilitasyon (delayed rehabilitation, DR) grubunu oluşturmaktaydı. Demografik özellikler, ameliyat öncesi ve ameliyat sonrası Amerikan Omuz ve Dirsek Cerrahları (American Shoulder and Elbow Surgeons, ASES) skoru, Sabit Murley (Constant Murley, CM) skoru, görsel analog skala (visual analogue scale, VAS) ve 36 maddelik Kısa Form Sağlık Anketi (SF-36) skorları değerlendirildi. Bulgular: Artroskopik RMO sonrası ASES, CM, VAS ve SF-36 skorlarının iyileşmesinde ER ve DR grupları arasında anlamlı bir fark saptanmadı. İki grup arasında takip süresince gelişen tekrar yırtık nüksü, donuk omuz ve enfeksiyon gibi komplikasyonlar açısından fark yoktu. Her iki rehabilitasyon protokolünün de hasta tarafından bildirilen sonuçlar üzerinde benzer bir etkiye sahip olduğu görüldü. Sonuç: Ortalama 13 aylık bir takip süresinde, erken ve gecikmiş başlangıçlı postoperatif rehabilitasyon programları, benzer fonksiyonel ve yaşam kalitesi sonuçları ve komplikasyon oranları ile ilişkilidir. Bu nedenle DR, özellikle büyük yırtıklara sahip hastalarda öncelikli olarak tercih edilebilir. ER, işe ve günlük hayata erken dönüş beklentisi olan küçük yırtıklara sahip hastalar için bir seçenek olabilir.

Keywords

• Omuz
• Artroskopi
• Rotator manşet yaralanmaları
• Rehabilitasyon

Comparison of Rehabilitation Programs After Arthroscopic Rotator Cuff Repair in Terms of Timing

Abstract

Aim: The aim of this study was to determine and compare the effects of early and delayed passive joint rehabilitation protocol on functional and quality of life outcomes in patients following arthroscopic rotator cuff repair (RCR). Material and Methods: A total of 202 patients who underwent arthroscopic RCR were included into the study. Ninety eight patients who started the rehabilitation program just after the arthroscopic RCR were comprised as early rehabilitation (ER) group, while 104 patients whose shoulder joint motion was not allowed for 3 weeks after surgery as delayed rehabilitation (DR) group. Demographic characteristics, preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant Murley (CM) score, visual analogue scale (VAS), and the 36-item Short Form Health Survey (SF-36) scores were evaluated. Results: There was no significant difference between the ER and the DR groups in terms of improvement of ASES, CM, VAS and SF-36 scores after arthroscopic RCR. There was no difference between two groups in terms of complications such as re-tear, frozen shoulder and infection that developed during the follow-up period. Both rehabilitation protocols were found to have a similar effect on patient-reported outcomes. Conclusion: At a mean follow-up time of 13 months, early and delayed onset postoperative rehabilitation programs are associated with similar functional and quality of life outcomes, and complication rates. Therefore, DR can be preferred primarily in patients with large tears. ER can be an option for the patients with small tears who has anticipation of early return to work and daily life.

Keywords

• Shoulder
• Arthroscopy
• Rotator cuff injuries
• Rehabilitation

References

1. Cuff DJ, Pupello DR. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol. J Shoulder Elbow Surg. 2012;21(11):1450-5.
2. Ross D, Maerz T, Lynch J, Norris S, Baker K, Anderson K. Rehabilitation following ar-throscopic rotator cuff repair: a review of current literature. J Am Acad Orthop Surg. 2014;22(1):1-9.
3. Keener JD, Galatz LM, Stobbs-Cucchi G, Patton R, Yamaguchi K. Rehabilitation following arthroscopic rotator cuff repair: a prospective randomized trial of immobilization com-pared with early motion. J Bone Joint Surg Am. 2014;96(1):11-9.
4. Kim YS, Chung SW, Kim JY, Ok JH, Park I, Oh JH. Is early passive motion exercise necessary after arthroscopic rotator cuff repair? Am J Sports Med. 2012;40(4):815-21.
5. Riboh JC, Garrigues GE. Early passive motion versus immobilization after arthroscopic rotator cuff repair. Arthroscopy. 2014;30(8):997-1005.
6. Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox RB 3rd. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016;25(4):521-35.
7. 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(1):106-13.
8. Li S, Sun H, Luo X, Wang K, Wu G, Zhou J, et al. The clinical effect of rehabilitation following arthroscopic rotator cuff repair: A meta-analysis of early versus delayed passive motion. Medicine (Baltimore). 2018;97(2):e9625.

9. 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(1):71-7.
10. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563-7.
11. Düzgün İ, Baltacı G, Atay OA. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain and functional activity. Acta Orthop Traumatol Turc. 2011;45(1):23-33.
12. Koh KH, Lim TK, Shon MS, Park YE, Lee SW, Yoo JC. Effect of immobilization without passive exercise after rotator cuff repair: randomized clinical trial comparing four and eight weeks of immobilization. J Bone Joint Surg Am. 2014;96(6):e44.
13. Düzgün İ, Baltacı G, Turgut E, Atay OA. Effects of slow and accelerated rehabilita-tion protocols on range of motion after arthroscopic rotator cuff repair. Acta Orthop Traumatol Turc. 2014;48(6):642-8.
14. Kjær BH, Magnusson SP, Henriksen M, Warming S, Boyle E, Krogsgaard MR, et al. Effects of 12 weeks of progressive early active exercise therapy after surgical rotator cuff repair: 12 weeks and 1-year results from the CUT-N-MOVE randomized controlled trial. Am J Sports Med. 2021;49(2):321-31.
15. Sheps DM, Silveira A, Beaupre L, Styles-Tripp F, Balyk R, Lalani A, et al. Early active motion versus sling immobilization after arthroscopic rotator cuff repair: A randomized controlled trial. Arthroscopy. 2019;35(3):749-60.
16. Lastayo PC, Wright T, Jaffe R, Hartzel J. Continuous passive motion after repair of the rotator cuff. A prospective outcome study. J Bone Joint Surg Am. 1998;80(7):1002-11.
17. Choi S, Seo KB, Shim S, Shin JY, Kang H. Early and delayed postoperative rehabilitation after arthroscopic rotator cuff repair: A comparative study of clinical outcomes. Clin Shoulder Elb. 2019;22(4):190-4.
18. Gutiérrez-Espinoza H, Araya-Quintanilla F, Pinto-Concha S, Zavala-González J, Gana-Hervias G, Cavero-Redondo I, et al. Effectiveness of supervised early exercise program in patients with arthroscopic rotator cuff repair: Study protocol clinical trial. Medicine (Baltimore). 2020;99(4):e18846.
19. Gallagher BP, Bishop ME, Tjoumakaris FP, Freedman KB. Early versus delayed rehabilitation following arthroscopic rotator cuff repair: A systematic review. Phys Sportsmed. 2015;43(2):178-87.
20. Longo UG, Rizzello G, Petrillo S, Loppini M, Maffulli N, Denaro V. Conservative rehabilitation provides superior clinical results compared to early aggressive rehabilitation for rotator cuff repair: A retrospective comparative study. Medicina (Kaunas). 2019;55(8):402.
21. Kluczynski MA, Nayyar S, Marzo JM, Bisson LJ. Early versus delayed passive range of motion after rotator cuff repair: A systematic review and meta-analysis. Am J Sports Med. 2015;43(8):2057-63.
22. Chen L, Peng K, Zhang D, Peng J, Xing F, Xiang Z. Rehabilitation protocol after arthroscopic rotator cuff repair: early versus delayed motion. Int J Clin Exp Med. 2015;8(6):8329-38.
23. Chan K, MacDermid JC, Hoppe DJ, Ayeni OR, Bhandari M, Foote CJ, et al. Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis. J Shoulder Elbow Surg. 2014;23(11):1631-9.
24. Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX. Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014;134(9):1279-85.
25. Bakti N, Antonios T, Phadke A, Singh B. Early versus delayed mobilization following rotator cuff repair. J Clin Orthop Trauma. 2019;10(2):257-60.
26. Chen Y, Jiang F, Li H, Chen S, Qiao Y, Li Y, et al. Retears and concomitant functional impairments after rotator cuff repair: Shoulder activity as a risk factor. Am J Sports Med. 2020;48(4):931-8.
27. Peltz CD, Dourte LM, Kuntz AF, Sarver JJ, Kim SY, Williams GR, et al. The effect of postoperative passive motion on rotator cuff healing in a rat model. J Bone Joint Surg Am. 2009;91(10):2421-9.
28. Sarver JJ, Peltz CD, Dourte L, Reddy S, Williams GR, Soslowsky LJ. After rotator cuff repair, stiffness--but not the loss in range of motion--increased transiently for immobilized shoulders in a rat model. J Shoulder Elbow Surg. 2008;17(1 Suppl):108-13.
29. Kovacevic D, Rodeo SA. Biological augmentation of rotator cuff tendon repair. Clin Orthop Relat Res. 2008;466(3):622-33.
30. Henriksson M, Rockborn P, Good L. Range of motion training in brace vs. plaster immobilization after anterior cruciate ligament reconstruction: a prospective randomized comparison with a 2-year follow-up. Scand J Med Sci Sports. 2002;12(2):73-80.
31. Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38(12):2435-42.
32. Mazzocca AD, Arciero RA, Shea KP, Apostolakos JM, Solovyova O, Gomlinski G, et al. The effect of early range of motion on quality of life, clinical outcome, and repair integrity after arthroscopic rotator cuff repair. Arthroscopy. 2017;33(6):1138-48.