JSES - 2026-08-01 - Journal Article
Rehabilitation protocols after arthroscopic rotator cuff repair: a survey of active members of the Korean Shoulder and Elbow Society.
Jeong HJ, Kim JY, Cho NS, Kong CG, Kim JH, Bang JY, Shim SD, Lee SJ, Lee YB, Yoo YS, Lee JH, Noh YM, Lee HM, Ji JH, Kim CH, Rhie TY, Park JY, Kim SM, Lim TK
Topics
Key Takeaway
Among 113 Korean shoulder surgeons, 92.9% adjust immobilization duration by tear size (r=0.648, p<0.001), but only 43.4% initiate any rehabilitation during immobilization for medium-sized tears, revealing substantial protocol heterogeneity.
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Summary
This survey queried 140 active KSES members on postoperative rehabilitation practices following arthroscopic rotator cuff repair, achieving an 80.7% response rate from surgeons with mean 14.5 years experience. For a medium-sized tear scenario, 96.5% began ROM after brace removal, 80.5% started strengthening at 3.1±0.9 months, and return-to-work timing correlated strongly with labor intensity (r=0.702, p<0.001). Universal abduction brace use and multimodal analgesia with injection therapy as a second-line option (76.1%) were consistent findings, but early rehabilitation initiation during immobilization was practiced by fewer than half.
Key Limitation
Survey responses reflect stated intent rather than actual clinical behavior, introducing social desirability bias that may overestimate protocol consistency.
Original Abstract
BACKGROUND
Despite the clinical importance of rehabilitation after arthroscopic rotator cuff repair, standardized postoperative rehabilitation protocols are yet to be established. Therefore, this study aimed to investigate the current consensus on rehabilitation protocols after arthroscopic rotator cuff repair among active members of the Korean Shoulder and Elbow Society (KSES). We hypothesized that rehabilitation protocols would vary and that there might be a tendency to adjust rehabilitation based on the preoperative tear size and level of physical demand of the individual patient.
METHODS
Between November 2023 and February 2024, an anonymous electronic survey questionnaire was distributed to 140 active members of the KSES under the auspices of the KSES Public Relations Committee. It assessed the surgeon's level of experience, rehabilitation protocols, and whether adjustments were made to the immobilization period based on tear size. Additionally, the clinical scenario of a medium-sized rotator cuff tear was used to analyze the consensus on detailed rehabilitation protocols, including immobilization, postoperative pain management, and timing of return to daily activities.
RESULTS
A total of 113 expert shoulder surgeons, with a mean clinical experience of 14.5 ± 7.6 years, responded to the survey (response rate 80.7%). All respondents reported using an abduction brace, and 92.9% adjusted the immobilization duration based on the tear size (r = 0.648, P < .001). In a medium-sized rotator cuff tear scenario, 43.4% initiated rehabilitation during immobilization. Range of motion exercise was started after brace removal by 96.5% and strengthening by 80.5% at postoperative 3.1 ± 0.9 months. Patient-performed self-exercise was preferred over supervised physiotherapy or continuous passive motion machine. Analgesic use declined over time, with more pronounced reductions in opioids and acetaminophen than in nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. Injection therapy was considered by 76.1% of surgeons to manage pain that was not adequately controlled by oral analgesics. Return to work (85.8%) and sports activities (77.0%) were adjusted based on labor (r = 0.702, P < .001) and sports intensity (r = 0.367, P < .001), respectively.
CONCLUSIONS
Despite variations in detailed protocols, the structured framework based on tear size and physical demands observed among the active members of the KSES, coupled with the preference for patient-directed rehabilitation and multimodal pain control, may suggest future efforts toward developing evidence-based and culturally adaptable rehabilitation guidelines. Further studies with higher levels of evidence are required to establish standardized and effective rehabilitation protocols.
LEVEL OF EVIDENCE
Level V, Expert Opinion.