| Popis: |
In spite of good clinical results there is high re-rupture rate after arthroscopic rotator cuff repair, which is between 25% to 40%. Many factors are involved in healing or structural failure of the repaired rotator cuff tendons. The primary factors for rotator cuff healing are age and tear size. Postoperative rehabilitation has also influence on rotator cuff healing, which the surgeon can determine. The re-tear rate of the aggressive early passive motion is more than twice the rate of the limited early passive motion. Postoperative early motion could affect structural integrity of the repaired rotator cuff tendon and limited early passive motion is recommended after arthroscopic rotator cuff repair. Postoperative rehabilitation protocol should be made on the intraoperative findings, which include: size and the type of the tear, quality of the bone and remnant tendon tissue, mobility of the tendons and tension after fixation. Intraoperative findings of the rotator cuff tear dictate postoperative rehabilitation. Smaller tears and particularly partial intra-articular tears have significantly higher rates of postoperative stiffness versus large and massive tendon tears. Additional significant risk factors for postoperative stiffness are calcific tendinitis, adhesive capsulitis and concomitant labral repair. To escape postoperative stiffness small supraspinatus tear with a good quality of the remnant tendon with a good fixation should have early rehabilitation. Massive rotator cuff tears with retraction medially and pure quality of tissue and with a limited mobility is candidate for slow rehabilitation. Furthermore, different type of the tear needs a different surgical technique. For example, medial retraction of the supraspinatus tendon with limited mobility, which hardly reach the footprint need a simple row fixation and slow postoperative rehabilitation. Good quality of tissue, good bone on the footprint and good mobility even in massive cuff tear should be fixed by transosseous or double-row technique are needs an early rehabilitation. Another issue is preoperative stiffness in patients undergoing arthroscopic rotator cuff repair and postoperative rehabilitation. What to do with a patient with preoperative stiff shoulder that is going for arthroscopic rotator cuff repair? What type of postoperative rehabilitation, early aggressive or slow? Does to do preoperative rehabilitation to try to improve the range of motion or to do at the same time arthroscopic capsular release with rotator cuff repair or manipulation under anesthesia before arthroscopic rotator cuff repair? We have no answer for these questions until now. In conclusion, the character of the tear size can determine postoperative rehabilitation. Smaller tears can be mobilized earlier than the large or massive retracted tears after arthroscopic rotator cuff repair. |
