Postoperative Rotator Cuff Repair Rehabilitation and Complication Management

Selection and management of a postoperative rotator cuff repair rehabilitation protocol is a vital component in achieving pain control in patients, a reliable return to activities and preinjury level, retear risk management, and overall surgical outcome. Optimal treatment approaches require a team effort; open communication between the surgeon, the therapist, and the patient; continual reassessment; and a stepwise staged protocol progression. Much work has been done to identify high-level evidence-based rotator cuff rehabilitation protocols and identify risk factors for complications and tendon failure. The orthopedic surgeon is best positioned to identify predictive factors at the time of treatment that influence overall outcome and may direct and customize early rehabilitation based on these assessments. In addition, the surgeon is overall responsible for much of the postoperative decision making: ensuring an optimal environment for tendon healing, avoidance of postoperative stiffness, return to work or activity pressures, postoperative pain management, cost constraints of therapy, avoidance of revision surgery, and optimization of long-term outcome. Thus, a comprehensive understanding of the rotator cuff repair rehabilitation protocol is requisite. This article aims to review patient and surgical factors to consider in customizing the postoperative rehabilitation protocol, present postoperative assessments to guide surgical recovery and rehabilitation, and provide our current evidence-based rehabilitation protocol.