When Do Patients Return to Previous Daily Activity After Arthroscopic Rotator Cuff Repair?
Authors: Kim Hwan Jin , Kim Jung Youn , Rhee Yong Girl 
Published: January 2019

Abstract

Background
One potential advantage of arthroscopic shoulder surgery over open approaches is accelerated recovery; however, the functional recovery period of daily activities for specific movements after arthroscopic rotator cuff repair has not yet been reported, to our knowledge.

Questions/purposes
(1) After arthroscopic rotator cuff repair, when are patients able to perform low-level and high-level front-of-body motion, low-level and high-level behind-the-back motion, strength-related activities, and sports/leisure activities? (2) How do tear size, arm dominance, and retear affect performance of these activities? (3) When does the UCLA score cross above 80% in each UCLA score component (28 points)?

Methods
A 2-year prospective study of 135 patients who underwent arthroscopic rotator cuff repair was performed (45 in small-sized, 45 in medium-sized, and 45 in large-to-massive-sized groups). The mean age was 60 years. Thirty-one and 104 shoulders were nondominant and dominant shoulders, respectively. Twenty-seven shoulders showed retear on MRI taken 9 months after surgery. We evaluated the functional recovery periods using the questionnaire and the UCLA scores and assessed influencing factors such as tear size, arm dominance, and retear. The patients were asked to fill out a questionnaire at 1, 2, 3, 6, 9, 12, 15, 18, and 24 months after surgery. The questionnaire evaluated front-of-the-body, behind-the-back, general, simple strength-related, and sports/leisure activities. Based on the UCLA evaluation, the functional recovery period was defined as the time required to achieve a score > 80% in each UCLA score component.

Results
Patients experienced recovery of low-level and high-level ROM front-of-the-body, high-level ROM behind-the-back, simple strength-related, and sports/leisure activities within 2 ± 1, 3 ± 2, 9 ± 0, 10 ± 2, and 14 ± 3 months, respectively, after surgery. Two patients with large-to-massive tears did not gain the recovery of high-level ROM behind-the-back, simple strength-related, and sports/leisure activities. Patients with large-to-massive tears were delayed from some activities compared with patients with small tears (10 ± 0 versus 7 ± 1 for washing back, p = 0.010; 11 ± 0 versus 10 ± 0 for lifting 5 kg, p = 0.020; 15 ± 0 versus 13 ± 0 for sports/leisure). Arm dominance was not associated with functional recovery. Patients with retears, compared with intact healing, had a longer time to return to washing hair (3 ± 2 versus 3 ± 1, p = 0.007), combing (4 ± 3 versus 2 ± 1, p = 0.002), washing the back (10 ± 3 versus 8 ± 3, p = 0.034), and sports/leisure (15 ± 3 versus 14 ± 3, p = 0.010). UCLA score in 134 patients reached 28 points, corresponding to the functional recovery period at 6 ± 3 months. One patient did not reach > 28 points on the UCLA score.

Conclusions
It took patients an average of 14 months to recover their daily motion after surgery. Tear size and retear affected only the recovery period of high-level motion activities and sports/leisure. This study was believed to serve as a guideline to inform patients about functional recovery after arthroscopic rotator cuff repair.

Level of Evidence
Level III, therapeutic study.