At every orthopedic and physical therapy conference, there’s always a debate about rotator cuff repair surgery and postoperative rotator cuff physical therapy. There have been a number of studies published that have shown failure rates ranging from 25-90% for rotator cuff repair surgeries.
The news of such a high rate of failure is startling, but it’s important to consider what we mean when we say “failure,” because the term is more subjective than you may think. Typical study models define success as an intact rotator cuff, which is sensible. However, when you look at patients who’ve had “failed” repairs, many of them are often quite pleased with their postoperative outcome. While their surgeries have technically qualified as “failures,” they wind up with improved functionality in their shoulders, enough that they’re satisfied with their new quality of life. It’s unlikely that these patients consider their surgeries to have been “failures.” With that in mind, it’s important to reconsider our definition of “failure,” and consider how patient outcome and satisfaction factor into the success of a procedure.
In light of the debate over postoperative rotator cuff physical therapy, it seems that a number of physicians believe that the rotator cuff physical therapy is a cause for the procedures’ failures. This thinking is likely flawed, as factors such as tissue quality, tear severity, patient selection, surgical technique, and others have a tremendous impact on the failure rate of a procedure.
Additionally, we need to return to that consideration of how we define “failure,” because most rotator cuff physical therapy patients are happy with their recoveries. These patients consider their outcomes to be successful in that they have less pain, regained mobility, and have been able to return to functional activities. With surgical failure rates potentially reaching up to 90%, but a significant increase in satisfaction and outcomes of postoperative rotator cuff physical therapy patients, it’s worth asking ourselves if perhaps rotator cuff physical therapy is just as beneficial of a recovery method without surgery at all.
Can Rotator Cuff Physical Therapy Prevent the Need for Surgery?
In a study done by the MOON Shoulder Group, a multi-center network of research teams throughout the country, 381 patients with atraumatic full-thickness tears of the rotator cuff were followed for at least two years. Patients ranged from 31 to 90 years of age, with an average age of 62.
The patients underwent 6-12 weeks of nonoperative rotator cuff physical therapy that focused on basic rotator cuff strengthening, soft tissue mobilization, and joint mobilizations. After an assessment six weeks into the study, 9% of patients chose to have rotator cuff repair surgery. After a subsequent assessment six weeks later, 6% more patients chose to have surgery. By the time of the two-year follow-up, 26% of patients in total chose to have surgery. Studies have shown that if a patient doesn’t choose to have surgery within the first 12 weeks of nonoperative rehabilitation, it’s unlikely that they need to have surgery.
About 281 patients, which is almost 75% of the study, were able to avoid rotator cuff repair surgery by participating in rotator cuff physical therapy, even though they had full-thickness tears! Those numbers speak volumes for the benefits of rotator cuff physical therapy.