Yikes….makes me wonder how many of these re-ruptured under my care in the old-school days of see them 3x/wk x 12 weeks with aggressive ROM and initiation of strengthening at 6 weeks.

Thank you for posting this! I feel like my RTC repair patients have been either one of two types: superstars who cruise through rehab and the others who STRUGGLE. Especially during the transition phase out of the sling. Big offenders: the patient who uses their arm way too much the second they are out of the sling and the patient who stretches too aggressively at end range rather than staying in pain-free, gentler range with the cane exercises. And it’s 100% my fault because I need to be way more assertive about restrictions and understanding how delicate these structures are. The treatment algorithm in Appendix 2 is helpful. I fully respect and follow surgical protocols but what happens when things don’t go exactly as planned? I’ll be using that in the future.

I’ve read the articles talking about how early vs. late initiation of ranges make no differences in outcomes or function and the only difference is early achievement of range of motion. At the same time, I’ve had CI’s (not Myra) tell me in the past how one of the biggest mistakes that PT’s make is to not get the passive ROM as early as you can within the surgical guidelines. I too feel as if I want to be way more conservative with these folks. What’s the benefit vs. risk ratio here? The balance is way too tipped toward the risk side for me based on this review.

Anyone else not a fan of AAROM flexion with a cane when they’ve had a biceps tenodesis?

Thank you for posting this Eric. This is certainly a keeper for any orthopedic PT. Similar to the consensus statement for rehab on arthroscopic capsulolabral repair.

I feel like this article exposed many areas of ignorance on my part, and will certainly change the way I practice. A few points of interest for me:
– I really enjoyed the references to the amount of tissue healing that occurs at given time points post-operatively. Repair strength is still only 29-50% of normal at 12 weeks.
– Only performing ROM if you need to. “Repeated cyclic loads can have potentially detrimental effects on the suture-tendon interface.”
– “Patients who exhibit poor compliance show a relative risk of re-tear or non-healing that is 152 times higher than that of compliant patients.” That’s a great stat to have when educating patients.

Overall, my sense was that I am too aggressive in my rehabilitation of cuff repairs, and will certainly be more cautious moving forward.

This is such an invaluable document. Thank you for sharing. The EMG data that is given in the protocol phases is really helpful and appreciated. It gives me a visual reference to go along with the exercise being performed. I have in the past definitely moved these patients along faster than they should be. The algorithm provided in Appendix 2 is a nice reference to help organize my little brain and help aid in problem solving with these patients. While it is realized that each patient requires their own individual approach, the Appendix is particularly helpful when prescribing frequency of a HEP. I feel there is always a fine line between prescribing a home program that is beneficial to improving function, but does not reach a threshold of causing irritation or damage and allow healing. Having a better understanding of the tissues involved is obviously critical.