There is no consistent approach to rehabilitation following arthroscopic shoulder stabilisation surgery (ASSS) in the UK. The aim of this study was to agree a set of post-operative guidelines for ...clinical practice.
Expert stakeholders (surgeons, physiotherapists and patients) were identified via professional networks and patient involvement and engagements groups. A three-stage online Delphi study was undertaken. Consensus was defined by the OMERACT threshold of 70% agreement.
11 surgeons, 22 physiotherapists and 4 patients participated. It was agreed patients should be routinely immobilised in a sling for up to 3 weeks but can discard earlier if able. During the immobilisation period, patients should move only within a defined “safe zone.” Permitted functional activities include using cutlery, lifting a drink, slicing bread, using kitchen utensils, wiping a table, light dusting, pulling up clothing, washing/drying dishes. Closing car doors or draining saucepans should be avoided. Through range movements can commence after 4 weeks, resisted movements at 6 weeks. Patients can resume light work as they feel able and return to manual work after 12 weeks.
Return to non-contact sports when functional markers for return to play are met was agreed. Return to contact sport is based on function & confidence after a minimum of 12 weeks. Additional factors to consider when determining rehabilitation progression: functional/physical milestones, patient’s confidence and presence of kinesiophobia. The preferred outcome measure is the Oxford Instability Shoulder Score.
This consensus provides expert recommendations for the development of rehabilitation guidelines following ASSS.
•This paper is the first to provide expert recommendations for patients undergoing rehabilitation following arthroscopic shoulder stabilisation surgery.•This paper provides clinicians and patients with expert guidance on appropriate expectations regarding functional restriction and progression following arthroscopic shoulder stabilisation surgery.•In the absence of national clinical guidelines for this patient group, these recommendations will reduce variation and improve quality of care.•The knowledge acquired from this study will also lay the foundation for clinical guidelines to be developed.•The results of this study also demonstrate the need for further, empirical work to be carried out in this area.
Objective
This systematic review aimed to analyse the effect of early weight bearing versus late weight bearing on rehabilitation outcomes after ankle fractures, which primarily include ankle ...function scores, time to return to work/daily life and complication rates.
Methods
The China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal, Web of Science, PubMed, Embase and Cochrane Library databases were searched. The focus was on identifying randomised controlled trials centred on early weight‐bearing interventions for post‐operative ankle fracture rehabilitation. All databases were searched for eligible studies published within the period from database inception to 20 June 2023. The eligible studies were screened according to the inclusion criteria. Study quality was evaluated using the methodology recommended by the Cochrane Handbook for the Systematic Evaluation of Interventions. Two authors independently performed the literature search and data extraction. Eligible studies were subjected to meta‐analyses using Review Manager 5.3. Based on the time points at which post‐operative ankle function was reported in the studies included in this paper, we decided to perform a meta‐analysis of ankle function scores at 6 weeks post‐operatively, 12 weeks post‐operatively, 24–26 weeks post‐operatively and 1 year post‐operatively.
Results
A total of 11 papers, comprising 862 patients, were included. Meta‐analysis indicated that patients receiving early weight‐bearing interventions, which referred to weight‐bearing for 6 weeks post‐operatively, experienced enhancements in ankle function scores (Olerud–Molander score, AOFAS score or Baird–Jackson score) at various post‐operative milestones: 6 weeks (SMD = 0.69, 95% CI: 0.49–0.88 and p < 0.01), 12 weeks (SMD = 0.57, 95% CI: 0.22–0.92 and p < 0.01) and the 24–26 weeks range (SMD = 0.52, 95% CI: 0.20–0.85 and p < 0.01). The results of subgroup analyses revealed that the effects of early weight‐bearing interventions were influenced by ankle range‐of‐motion exercises. Additionally, early weight bearing allows patients to return to daily life and work earlier, which was evaluated by time when they resumed their preinjury activities (MD = −2.74, 95% CI: −3.46 to −2.02 and p < 0.01), with no distinct elevation in the incidence of complications (RR = 1.49, 95% CI: 0.85–2.61 and p > 0.05).
Conclusion
The results showed that early weight bearing is effective in improving ankle function among post‐operative ankle fracture patients and allows patients to return to daily life earlier. Significantly, the safety profile of early weight bearing remains favourable, with no higher risk of complications than late weight bearing.
Remote monitoring rehabilitation programs are new technologies growing in popularity for patients undergoing lower extremity total joint arthroplasty. The purpose of this study was to assess the ...patients' perceptions of these technologies.
Patients who underwent total hip arthroplasty (THA), total knee arthroplasty arthroplasty (TKA), and unicompartmental knee arthroplasty (UKA) from September 2020 to February 2022, and participated in a clinical study utilizing remote monitoring and an app-based rehabilitation program were given a questionnaire 3 months postoperatively to assess their perceptions of these technologies. There were 166 patients who completed the survey (42 THA; 106 TKA; 18 UKA).
There were 92% of patients who found the technology easy to use. A majority of patients felt the technologies motivated them. The TKA/UKA patients felt more strongly that these technologies allowed the surgeon to monitor their recovery closely (81.9% versus 65.9%; P = .009). There were 85% of THA patients and 94.5% of TKA/UKA patients recommended these technologies. The THA patients felt more strongly that digital rehabilitation could completely replace in-person physical therapy compared to TKA/UKA patients (85.4% versus 41.3%; P < .001). A majority (83%) of patients recommended a combination of inpatient and technology-assisted rehabilitation (THA 90.2%; 84.4% TKA/UKA).
The THA and TKA/UKA patients found remote monitoring rehabilitation easy to use, increased motivation, and recommend it to other patients undergoing lower extremity arthroplasty. They recommend a combination of technology and in-person rehabilitation postoperatively. The THA patients felt these technologies could replace in-person rehabilitation programs.
IV.
Post-operative elderly hip fracture patients require significant rehabilitation. Nandrolone is an anabolic steroid used to promote muscle growth. This study aims to examine the effect of nandrolone ...in improving rehabilitation and quality of life in elderly female patients with hip fractures undergoing hemiarthroplasty.
This is a double-blinded prospective randomized-controlled-trial consisting of female patients above the age of 65 with an isolated neck of femur fracture planned for a hip hemiarthroplasty. Participants were randomized into two arms of the study – 50 mg intramuscular nandrolone vs normal saline placebo administered on post-operative day 0, and weeks 2, 6 and 12. The participants were followed up across a 1-year period following the surgery. Clinical outcomes such as time taken to achieve rehabilitation milestones, distance of ambulation and thigh muscle girth, and functional scoring with SF-36 questionnaire were recorded at intervals of 2, 6 and 12 weeks, 6 months and 1 year following the surgery.
There were a total of 23 subjects with 11 in the steroid group and 12 in the placebo group. There was no significant difference in demographics and injury patterns between both groups. There was no significant difference for time taken to achieve various rehabilitation milestones and distance of ambulation. SF-36 scores on discharge and at 1-year follow-up mark were comparable. There was no difference in the complication rate between both groups.
Intra-muscular Nandrolone after hip surgery in elderly female patients does not result in short to mid-term improved rehabilitation or functional outcomes. Nandrolone did not result in increased short-term complications after hip surgery.
I.
Post-operative rehabilitation of patients is not less important, or even more important, than a technically perfect surgery procedure. A good functional result of treatment depends not only on ...surgery procedures, but also on an individually selected system of post-operative rehabilitation therapy, especially when it comes to athletes - patients with high functional requirements. Purpose. To improve the results of athletes' recovery after orthopedic surgery procedures on the forefoot, due to the restoration of a muscle function, responsible for the foot activity. Material and methods. We conducted prospective research on 36 patients engaged in different sports, with deformities and diseases of the forefoot, who had experienced surgery procedures aimed at repairing those deformities. All the patients were divided into 2 homogenous groups. The system of rehabilitation in the patients of the control group meant exercising in order to train a walking stereotype. The system of rehabilitation for the main group developed by us implied an effect of massage and special exercises on the following muscles and ligaments: m. tibialis anterior, m. fibularis longus, m. biceps femoris, lig. sacroischiadicus, tractus iliotibialis, m. tensor fascia latae, m. quadriceps femoris, m. adductor magnus, m. gluteus medius on both operated and healthy sides. The results of treatment were evaluated by the generally accepted assessment scale of AOFAS for the forefoot (module 2) 45, 60, 90 days after surgery procedures. The research data were statistically processed. Results. There was a statistically significant difference between the main and the control groups by the scale of AOFAS 60 days after a surgery procedure (MWUT, р < .01). The athletes of the main group were able to return to a training process 2 months after a surgery procedure on the forefoot, and those of the control group - 3 months after a surgery procedure. Conclusions. Massage and special exercises, aimed at restoring a stabilizing function of muscles and ligaments of stabilizers of not only the foot, but of the entire pelvic girdle and pelvis of both sides allowed reducing the dates of athletes' functional recovery by a month in comparison with the control group.
Emergency departments in the UK are overwhelmed with musculoskeletal trauma, 50 % of which resulting from ligamentous injuries. Of these, ankle sprains are the most prevalent, however with poor ...rehabilitation in the recovery period, 20 % of patients may develop chronic instability that may necessitate operative reconstruction. At present, there are no national guidelines or protocols to help direct postoperative rehabilitation and determine weightbearing status. Our aim is to review the existing literature that investigated postoperative outcomes following different rehabilitation protocols in patients with Chronic Lateral Collateral Ligament (CLCL) instability.
A literature search was performed via Medline, Embase and Pubmed databases using the terms ‘ankle’, ‘lateral ligament’, ‘repair’. ‘reconstruction’ and ‘early mobilisation’. A total of 19 studies were identified after filtering that they were English language papers. A gray literature search was also performed using the Google search engine.
Based on the literature reviewed, patients undergoing early mobilisation and Range Of Movement (ROM) following lateral ligament reconstruction for chronic instability seem to have better functional outcomes and earlier return to work and sports. This is however in the short-term, and there are no medium to long-term studies evaluating the effects of early mobilisation on ankle stability. Furthermore, there may be an increased risk of postoperative complications, mainly wound related, with early mobilization compared to delayed mobilization.
Further randomized studies and long-term prospective studies with larger cohorts of patients are required to improve the level of evidence available but based on current literature it would appear that controlled early ROM and weight-bearing is advisable in patients undergoing surgery for CLCL instability.
•20 % of patients sustaining ankle sprains may develop chronic instability.•Early mobilisation and ROM following LCL reconstruction for chronic instability may offer better functional outcomes and earlier return to work and sports.•There may be increased risk of postoperative complications, mainly wound related, with early mobilization compared to delayed mobilization.
Purpose of review
With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The ...rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications.
Recent findings
Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue. Recent electromyography studies have identified exercises which elicit highest level of muscle activation for individual dynamic stabilizers. The physical therapist should also be aware of potential complications and be prepared to manage appropriately if they should arise.
Summary
During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendon-to-bone healing. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. Advanced strengthening is initiated when all preceding criteria have been met. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames.
To determine the effect of local infiltration anesthesia (LIA) at the donor site combined with a femoral nerve block (FNB) on short-term postoperative pain, functional outcomes, and rehabilitation ...after arthroscopic hamstring tendon autograft anterior cruciate ligament reconstruction (ACLR).
This study was a single center, randomized controlled trial. Seventy-three subjects with ACL rupture were enrolled. Participants were randomly allocated to two groups, 47 in the experimental group (Group A) and 26 in the control group (Group B). All operations were performed under FNB. In Group A, 10 ml of 1% ropivacaine was injected precisely at the hamstring donor site. Patients in Group B were treated with the same amount of saline. Preoperatively and postoperatively, pain scores based on the numerical rating scale (NRS) and consumption of opioids were recorded. In addition, knee functions were assessed by the International Knee Documentation Committee Subjective Knee Form (IKDC), the Lysholm score, and the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and postoperatively at 1 and 3 months. In addition, we applied the KNEELAX3 arthrometer to evaluate the stability of the knee preoperatively and postoperatively so that subjective and objective knee conditions were obtained to help us assess knee recovery in a comprehensive manner.
The hamstring donor-site block reduced pain within the first 12 postoperative hours. There were no significant differences between two groups in pain intensity preoperatively and equal to or greater than 24 hours postoperatively. Furthermore, there were no differences between the groups concerning knee functions preoperatively or in the short-term follow-up at 1 and 3 months.
LIA at the donor site can effectively improve the early postoperative pain of patients after ACLR and reduce the use of opioids without affecting the functional outcomes of the surgery.
Purpose of Review
Arthroscopy has become increasingly popular for a addressing a wide variety of shoulder pathology. However, despite increasing interest, there is still much uncertainty and ...variability amongst providers regarding optimal post-operative rehabilitation. This review provides an overview of the evidence underlying common rehab protocols used following arthroscopic interventions for rotator cuff disease, shoulder instability, superior labral anterior to posterior (SLAP) tears and adhesive capsulitis.
Recent Findings
For small and medium sized rotator cuff tears, early motion protocols do not seem to affect healing or retear rates, however there is no difference with regards to long term functional outcomes when compared to standard motion protocols. For larger tears (> 3 cm), early active motion may be associated with impaired tendon integrity. Early range of motion following arthroscopic Bankart repair has not been shown to increase rate of recurrence, however the data on return to sport requires more granularity to effectively guide care. Further research needs to be done to compare rehab protocols following SLAP repair and arthroscopic capsular release.
Summary
Rehabilitation protocols following rotator cuff surgery and anterior shoulder stabilization have garnered the most research interest. However, there is still a need for larger higher-level studies examining the long-term effects of different rehab protocols. Regarding the arthroscopic management of other types of shoulder instability, SLAP tears and adhesive capsulitis, there is paucity of high-quality evidence. This knowledge gap likely underpins the variability in different rehab protocols seen in clinical practice, highlighting the need for more research.
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