Efficacy of informed versus uninformed physiotherapy on postoperative retear rates of medium-sized and large rotator cuff tears

Background: It is important to perform the first 12 weeks of rehabilitation without risk of tearing a cuff tendon from its repair site. Our hypothesis was that performing early postoperative rehabilitation with a limitable pendulum exercise device can produce lower retear rate outcomes when it is combined with safe, informed physiotherapy compared with a standardized protocol of rehabilitation performed at home.

Methods: By using an asymmetric arm support brace and an advanced accelerometer, we attempted to determine the benefits of small pendulum exercises (proposed by Long et al). This study enrolled 24 patients to use a monitoring device in standardized small pendulum exercises. Clinical outcomes and magnetic resonance images were evaluated preoperatively and 12 weeks after surgery.

Results: While a patient performed pendulum exercises, a therapist used computer imagery to observe whether vertical acceleration was over a given threshold (identified as physiologic tremors), as a warning of and precaution associated with the increased risk of repair failure. Similar self-reported functional outcomes were reported in 2 areas. The rate of recurrent tears was significantly higher for both the medium-sized and large areas in the uninformed home rehabilitation group compared with the informed group.

Conclusion: The results of monitoring of pendulum exercises to develop informed physical therapeutic methodology were consistent with those of previously published literature. In this study, use of a monitoring device during early rehabilitation was associated with lower retear rates after rotator cuff repair.