Rehabilitation protocols after arthroscopic rotator cuff repair: a survey of active members of the Korean Shoulder and Elbow Society

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.