Can You Tear Your Rotator Cuff Again After Surgery
March 15, 2018
two min read
After repair of a massive rotator cuff tear, how long of a delay should there be before patients return to demanding activity?
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At to the lowest degree a 6-month delay
Massive rotator cuff tears are typically defined every bit rupture of at to the lowest degree 2 of the four rotator cuff tendons and/or retraction away from the attachment site of 5 cm or greater. Thus, these are generally accepted as more challenging repairs with a longer recovery. Tendon healing to bone biologically takes three months. Strengthening typically volition not start until afterward this time, and therefore maximal recovery of strength tin have up to 1 twelvemonth. Nosotros must proceed with circumspection when rehabbing massive repairs as these repairs are at the highest risk for either re-rupture or not healing. Meta-analyses bear witness the overall re-tear rate of all rotator cuff repairs is effectually 26%; however, when massive repairs are isolated, some studies study upwards to a 91% non-healing rate. Although many factors are of import in predicting which rotator cuff tears will not heal, the size of the tear is paramount. Several studies have shown that despite many repairs not healing, clinical outcomes are nonetheless good. However, it has been shown shoulder strength is better if the repair heals and, therefore, every endeavor should exist fabricated to ensure healing. Several well-washed studies have shown rotator gage repairs are near vulnerable to re-tear or non-healing in the first 6 months after repair. Therefore, when considering all these factors, it would be wise to delay render to demanding action until at to the lowest degree the six-month mark. Withal, it is even wiser to begin to ease into full activity at the 6-month mark with a goal of full render betwixt half dozen months and 1 year postoperatively.
Julie Bishop, Doc, is director of the Division of Shoulder Surgery at The Ohio State University Wexner Medical Center in Columbus, Ohio.
Disclosure: Bishop reports no relevant fiscal disclosures.
Mature healing timeline unknown
The timeline for return to full physical activeness after rotator cuff repair is a peculiarly relevant topic given the active nature of some patients and the desire to return to full recreational and occupational demands. These desires, coupled with the unpredictable healing of massive rotator gage tears, make counseling patients post-obit rotator repair challenging on many levels.
The precise timeline for mature healing of the rotator gage in humans in largely unknown. Studies in large animals suggest a reasonable healing response occurs at 12 to 16 weeks although the tendon remains disorganized at these time points. Clinical research suggests gentle rotator gage strengthening is condom at 3 months for routine repairs. However, many surgeons advocate for delayed strengthening at 4 months for large to massive tears, allowing for a more mature healing response. Although the success of traditional rehabilitation for standard repairs has been well studied, the potential benefits of delayed rehabilitation for higher risk tears is largely unknown. Information technology is more often than not felt that 6 to 8 weeks of defended rotator gage strengthening is necessary before resumption of heavier lifting and normal gym-related activities.
Folio BREAK
Information technology has been shown the majority of re-tears following cuff repair happen in the first 6 months following surgery and recurrent tears that occur more the 1 year after successful healing are unusual. There is a known risk of recurrent tears in massive tears that by and large ranges from 25% to 40% depending on patient age and repair construct. When because the relatively high take a chance of re-tears in these tears combined with the "normal" healing timeline, it is appropriate to delay return to demanding activities for at least half dozen months post-obit surgery, perhaps longer. The rate of progression and ultimate limitations for these patients must be individualized based upon progress in rehabilitation and return of cuff force.
Jay D. Keener, Dr., is an associate professor, chief of Shoulder and Elbow Service and fellowship director in the department of orthopedic surgery at Washington University, in St. Louis.
Disclosure: Keener reports he received a grant from the NIH.
Source: https://www.healio.com/news/orthopedics/20180312/after-repair-of-a-massive-rotator-cuff-tear-how-long-of-a-delay-should-there-be-before-patients-retu
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