title: Immediate passive motion versus immobilization after endoscopic supraspinatus tendon repair: a prospective randomized study.
abstract: BACKGROUND
  Rehabilitation programs after rotator cuff repair should allow recovery of shoulder function without preventing tendon healing. The aim of this randomized prospective study was to compare the clinical results after two types of postoperative management: immediate passive motion versus immobilization.
  
  
  METHODS
  We followed 100 patients, mean age 55 years old, who underwent arthroscopic repair of a non-retracted supraspinatus tear. Patients were randomized to receive postoperative management of immediate passive motion or strict immobilization for 6 weeks. A clinical evaluation was performed in 92 patients, and CT arthrography in 82. Mean follow-up was 15 months.
  
  
  RESULTS
  The mean preoperative Constant score improved significantly from 46.1 points to 73.9 at the final follow-up. The rate of intact cuffs was 58.5%. Functional results were statistically better after immediate passive motion with a mean passive external rotation of 58.7° at the final follow-up versus 49.1° after immobilization (P=0.011), a passive anterior elevation of 172.4° versus 163.3° (P=0.094) respectively, a Constant score of 77.6 points versus 69.7 (P=0.045) respectively, and a lower rate of adhesive capsulitis and complex regional pain syndrome. Results for healing seemed to be slightly better with immobilization, but this was not statistically significant: the cuff had a normal appearance in 35.9% of cases after immobilization compared to 25.6% after passive motion, an image of intratendinous addition was found in 25.6% versus 30.2%, punctiform leaks in 23.1% versus 20.9%, and recurrent tears in 15.4% versus 23.3% respectively.
  
  
  CONCLUSIONS
  The rehabilitation program that results in better tendon healing by preventing postoperative stiffness has not yet been identified. Our results suggest that early passive motion should be authorized: the functional results were better with no significant difference in healing.
authors.affiliation: Department of Surgery for Upper Extremity, Hip and Knee, Strasbourg University Hospitals, Hand Surgery Center, 10, avenue Achille-Baumann, 67400 Illkirch-Graffenstaden, France.
authors.forename: J
authors.initials: J
authors.lastname: Arndt
authors.forename: P
authors.initials: P
authors.lastname: Clavert
authors.forename: P
authors.initials: P
authors.lastname: Mielcarek
authors.forename: J
authors.initials: J
authors.lastname: Bouchaib
authors.forename: N
authors.initials: N
authors.lastname: Meyer
authors.forename: J-F
authors.initials: JF
authors.lastname: Kempf
mesh_terms: D000368:Aged; D001175:Arthrography / Q000379:methods; D001182:Arthroscopy / Q000379:methods / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D018570:Risk Assessment; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D018709:Statistics, Nonparametric; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome