Summary

Our study shows that the speed of recovery of passive ROM influences tendon healing after isolated arthroscopic SSN repair. Indeed, repairs that resulted in healing had lower AE and ER up to 3 months after surgery compared to those that did not heal. However, this difference did not affect the level of pain and/or shoulder function, which were similar

Abstract

Introduction

The purpose of this study was therefore to analyze the impact of the speed of recovery of ROM on tendon healing and functional outcome in patients undergoing an isolated arthroscopic supraspinatus (SSN) repair and the same postoperative rehabilitation protocol. We hypothesized that a faster ROM recovery would lead to a better functional outcome without compromising SSN repair healing.

Material And Methods

This was a prospective monocentric study. All primary isolated arthroscopic SSN repairs for small to medium tears, without retraction (Patte 1), significant fatty infiltration (Goutallier <2) and associated glenohumeral osteoarthritis were eligible. Patients who did not complete all postoperative follow-ups were excluded. An experienced orthopedic surgeon performed all procedures using a standard double-row technique. All patients followed the same rehabilitation protocol postoperatively. It included the use of a sling and progressive passive overhead stretches and external rotation (ER) with the elbow at side during the first 6 weeks. An independent observer assessed all patients before and at 6 weeks, 3, and 6 months after surgery. Collected data at each follow-up included passive and active anterior elevation (EA) and ER as well as the visual analogue scale (VAS) for pain. In addition, the Constant score was obtained before and at 6 months after surgery. A single and experienced radiologist examined the healing of the repair by ultrasound at 6 months postoperatively. The integrity of the repair was classified into 5 categories according to Sugaya. Types 1 to 3 were considered as healed.

Results

1323 consecutive patients between 2010 and 2020 were eligible. 169 were excluded according to the aforementioned criteria. Finally, 1154 arthroscopic SSN repairs were included. The healing rate was 87.3%. Table 1 presents the following results in detail. Preoperative characteristics of healed and non-healed repairs were similar in terms of passive and active ROM, VAS pain, and Constant score. Compared to the non-healed repairs, the healed ones were slightly younger (57.8±8.0 vs. 61.5±8.5 years; p<0.001) and had a lower passive AE and ER at 6 weeks and 3 months postoperatively. However, this difference faded by 6 months after surgery. There was no difference in Constant score and VAS pain between healed and non-healed repairs. In both cases, the SSN repair resulted in an improvement of the Constant score at 6 months postoperatively and a decrease in the VAS pain already from the 6th postoperative week.

Discussion

Our study shows that the speed of recovery of passive ROM influences tendon healing after isolated arthroscopic SSN repair. Indeed, repairs that resulted in healing had lower AE and ER up to 3 months after surgery compared to those that did not heal. However, this difference did not affect the level of pain and/or shoulder function, which were similar. These results illustrate the importance of the immediate postoperative rehabilitation phase on tendon healing and support the hypothesis that an initial period of rest without active mobilization or at least with protected mobilization increases the chances of tendon healing.