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Early versus late physiotherapy following arthroscopic repair of small and medium size rotator cuff tear: a randomized clinical trial

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A Letter to the Editor to this article was published on 09 September 2023

Abstract

Purpose

We compared early and late physiotherapy for patients with small and medium size rotator cuff tears following arthroscopic repair.

Methods

A single-centre, single-blinded, prospective parallel RCT was performed with two arms: early physiotherapy (start within the first week) versus late physiotherapy (start 4 weeks after surgery). Patients with small- to medium-sized isolated full-thickness superior rotator cuff tears were included and followed for 12 months. The primary outcome measures were shoulder function and range of motion (ROM) measured by the Constant-Murley score (CMS) at three months, six months, and 12 months. The other outcomes were the visual analog scale (VAS) pain and the rotator cuff ultrasound (US) evaluation by the Sugaya classification.

Results

In three and six month follow-ups, CMS was significantly superior in the intervention group compared to controls (P < 0.05). However, only at the three month follow-up between-group difference met the minimal clinically important difference (MCID) (MCID = 10.4) (59.8 vs. 48.9). The intervention group experienced less pain than controls in the first six months (P < 0.001), and only the three month follow-up was clinically meaningful based on MCID (MCID = 1.4). Moreover, in the first six months, the shoulder ROM favoured the intervention group (P < 0.05). US grading of the supraspinatus and infraspinatus was similar between groups (P = 0.07). One retear occurred in the intervention group and another in the controls, detected by examination and US evaluation.

Conclusion

Following the arthroscopic repair of a small- to medium-sized rotator cuff tear, early physiotherapy showed promising results for pain, function, and range of motion.

Level of evidence: Level I therapeutic

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Data availability

The data that support the findings of this study are available from the corresponding author, Nima Bagheri and Mohamad Reza Guity, upon reasonable request.

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Author notes

  1. Mohammad Reza Guity and Peyman Mirghaderi contributed equally to this work.

Authors and Affiliations

  1. Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Mohammad Reza Guity, Peyman Mirghaderi, SM Javad Mortazavi, Alireza Moharrami, Nima Bagheri & Sadula Sharifpour

  2. Surgical Research Society (SRS), Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Peyman Mirghaderi

  3. Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Radiology Department, Imam Khomeini Hospital Complex (IKHC), Tehran University of Medical Sciences (TUMS), Tehran, Iran

    Mahrooz Malek

  4. Shoulder and Elbow Fellowship, Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Nima Bagheri

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Contributions

N.B. and MR.G. contributed to the study conception and design and supervised the project. P.M. and A.M. analyzed the data and wrote the first draft of the manuscript. S.Sh. gathered the data, did assessments, contributed to the study design, and edited the manuscript. SMJ.M. contributed to the study design, revised the manuscript, and drew figures. M.M. did sonographies and edited the manuscript. All authors commented on previous versions of the manuscript and revised it. All authors read and approved the final manuscript. S.Sh. and P.M. contributed equally to this work.

Corresponding authors

Correspondence to Nima Bagheri or Sadula Sharifpour.

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The study was reviewed and approved by the Institutional Review Board of Tehran University of Medical Sciences (Clinical trial registry code: IRCT20210526051412N1, https://www.irct.ir).

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Guity, M.R., Mirghaderi, P., Mortazavi, S.J. et al. Early versus late physiotherapy following arthroscopic repair of small and medium size rotator cuff tear: a randomized clinical trial. International Orthopaedics (SICOT) 47, 2795–2807 (2023). https://doi.org/10.1007/s00264-023-05924-5

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