Several factors can affect the extent and speed to which a person recovers after any surgical repair. Some factors are pretty obvious like the severity of the injury. Other prognostic factors may be less clear or understood. Therefore, a better understanding of these “factors may lead to a better understanding of why the recovery process is successful in some patients but not in others.” So with that objective in mind, a systematic review on the factors that lead to a successful recovery after arthroscopic rotator cuff repair will soon be published. In it, they found the following factors lead to a better outcome and recovery from a rotator cuff surgery:
- demographic factors (younger age, male gender)
- clinical factors (higher bone mineral density, absence of diabetes mellitus, higher level of sports activity, greater preoperative range of motion, absence of obesity)
- factors related to cuff integrity (smaller sagittal size of the cuff lesion, less retraction of the cuff, less fatty infiltration, no multiple tendon involvement)
- factors related to the surgical procedure (no concomitant biceps or acromioclavicular joint procedures).
In short, here’s my take away thoughts on this:
- Patients should demand “pre-hab” (ie PT before their surgery). Pre-hab should include any technique that will improve the patient’s ROM. Better ROM before Surgery=Better outcomes. Why not invest a couple weeks beforehand so that the patient is maximizing their potential and decreasing the need for overall PT after the surgery; 2 weeks before is better than adding 4 extra weeks after the surgery. Further, during pre-hab the clinician can improve motor control deficits in movement patterns and other joints that play a large role in overall ROM such as the scapulothoracic joint. Additional reinforcement may be given on ergonomic education and posture. Maximizing a solid movement foundation will benefit the patient and the surgeon’s outcomes! Remember, the surgeons really care about the outcomes too, so letting them know the benefit of pre-hab will entice them to prescribe pre-hab PT more consistently.
- Should we allow patients to consider surgical repair with several of the above factors? How much function can we restore with PT? Patients should be educated that traditional PT and overall conservative care will likely be more beneficial in the long run than surgery, especially when you do not have a few of the factors listed above. In fact, nearly 75% of patients can avoid rotator cuff repair surgery by performing physical therapy despite having full thickness cuff tears as seen in this study. Mike Reinold wrote up a good piece on this already if you like to read more. Often, pre-hab may be enough!
If you're a patient or a PT/healthcare specialist, demand good care not just after a surgery but before hand too!
