A new Hospital for Special Surgery study suggests that the current rehabilitation used for patients undergoing tendon-bone repairs such as rotator cuff repair may be partially to blame for the high rates of failed healing after surgery. Experiments in a rat model of this injury suggest that immobilizing the limb for four to six weeks after surgery, rather than quickly starting physical therapy, improves healing.
"Before we did this study, we thought that delaying motion for a short period of time, seven to ten days, and then starting physical therapy would be the most beneficial to tendon healing. However, from the data in this study, it appears we should be immobilizing our patients for longer periods of time," said Scott Rodeo, M.D., principal investigator of the study and co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery (HSS) in New York City.
Carolyn Hettrich, M.D., MPH, who was an HSS resident when she conducted the study, will present the study July 14 at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held in Baltimore.
The rotator cuff is a set of a four small muscles in the shoulder that allow the upper arm to rotate. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. During a repair surgery, a surgeon reattaches the tendon to the bone and a surgery's success is dependent on how well the interface between the tendon and bone heals. Studies have shown that 20%-40% of patients undergoing rotator cuff surgery have failed healing. These patients have poorer outcomes, including decreased strength and decreased range of motion.
Rehabilitation after rotator cuff surgery usually consists of immobilizing the shoulder in a sling for seven to ten days, physical therapy with passive and assisted motion for six weeks, followed by physical therapy with active motion for six weeks. However, there is little
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Hospital for Special Surgery