If you’re considering surgery for a Rotator Cuff tear, an important thing to consider is how long, and what’s involved in, the Rotator Cuff Surgery Recovery Timeline. But let’s begin with the Rotator Cuff itself.
What is the Rotator Cuff?
The rotator cuff is a group of four muscles and tendons that stabilize the ball and socket shoulder joint (1). The four muscles that compromise the rotator cuff are the supraspinatus, infraspinatus, subscapularis and teres minor. The rotator cuff is also important in shoulder functions such as reaching overhead, rotation and putting your hand into your back pocket. Tendons attach muscles to bones. Tendons are susceptible to acute inflammation, tendinosis, chronic inflammation, and tears, Tears can be partial thick or full-thickness. Tears in the rotator cuff can occur as a result of overuse, or acute injury.
What is Rotator Cuff Surgery?
Rotator cuff surgery involves repair of one or more of the rotator cuff tendons. The procedure can be done through a large incision (open) or a shoulder arthroscopy which uses a small camera that allows visualization of the joint and rotator cuff tendons. The repair involves reattachment of the torn rotator cuff tendon to the bone utilizing anchors. The anchor attaches the tendon to the bone. Shoulder arthroscopy is the most common surgical technique. From 1996 to 2006, the number of shoulder arthroscopies increased by 600%, including an overall 115% increase in the number of rotator cuff repairs (2).
What is the Rotator Cuff Surgery Recovery Timeline?
The Rotator Cuff Surgery Recovery Timeline varies significantly and can take 6 months or more. A shoulder immobilizer may be required for 4-6 weeks for maximal healing. There are four common phases.
Phase 1:Passive motion: 1-6 weeks depending upon the size of tear and strength of the repair.
Phase 2: Active Motion: 6-12 weeks. You start moving your shoulder with the contraction of your muscles.
Phase 3: Strengthening: 12-16 weeks. Injury, surgery, early phases of restricted motion result in weakness that now must be restored.
Phase 4 Full activity: 16-24 weeks. Strengthening with continued improvement in range of motion and return to play.
Different rehabilitation protocols have been evaluated. In a recent study, 64 patients were followed after rotator cuff surgery. Aggressive early passive rehabilitation was compared to early passive rehabilitation with no significant difference between the two groups at 1 year. Unfortunately, 23.3% of the patients that underwent aggressive early rehabilitation had re-tears of the rotator cuffs (3). Immobilization vs early mobilization following surgical repair has also been evaluated with no difference in tendon healing or clinical outcome (4).
Post-surgery recovery time period has been evaluated by using an 80% or better score on the Japanese Orthopedic Accosication shoulder scoring system. In a recent study, 201 patients who underwent arthroscopic rotator cuff surgery were followed postoperatively. 40% of patients took between 3-6 months to recovery whereas 28% took greater than 6 months (5) Rotator cuff surgery recovery time was shorter for younger patients without shoulder stiffness and smaller tears.
Is Rotator Cuff Surgery Effective?
The effectiveness of surgery in the treatment of rotator cuff tears has been questioned. Why?
A recent study demonstrated no clinically significant difference between surgery and active physiotherapy in a 1-year follow-up in improving function or reducing pain caused by rotatorcuff tears (6).
A meta-analysis of 57 randomized controlled trials [RCTs]) found that full-thickness rotator cuff tears improved with or without surgery (7).
A recent review by the Agency for Healthcare Research and Quality looked at more than 150 published papers and concluded that there is no solid evidence that surgery was superior to conservative treatment (8).
Complications from Rotator Cuff Surgery
Stiffness with Restriction in Range of Motion
Shoulder range in motion is critical to both function and joint health. A recent study found that shoulder motion and stability were not restored by rotator cuff surgery (9).
Re-tears in the Tendons
Large rotator cuff tears that undergo surgical repair have re-tear at a rate of 57% in a series of 500 patients (10). Treatment options include additional surgery.
Non-Healing
In patients over 60 years of age who undergo surgical rotator cuff repair, 33% will fail to heal at one year (11). Additional surgery is often required.
Are There Ways to Avoid the Long Rotator Cuff Tear Surgery Recovery Timeline?
Yes! Mesenchymal stem cells are found in various body tissues including bone and fat. They are the all-purpose repairmen of the body and these have the ability to help tendon injuries heal (12). In 2015 we published the first research paper on the use of bone marrow-derived stem cells in the treatment of rotator cuff tears in patients with and without arthritis. Precise injections of bone marrow stem cells resulted in a reduction in pain and improvement in function in the 115 shoulders 2 years post-injection (13). In a different study, patients with rotator cuff tears were randomized to undergo precise injections with bone marrow-derived stem cells and PRP or physical therapy for shoulder pain. Bone marrow-derived stem cells injections provided improved shoulder function, reduction in pain, and healing of tears when compared to physical therapy.
To Conclude…
The rotator cuff is a complex of muscles and tendons that provide stability and function to the shoulder. Injuries can occur and surgery for rotator cuff tears has increased. Recovery from rotator cuff surgery is commonly divided into 4 phases. Healing and function vary significantly based on age, shoulder stiffness, and size of the tear. In a recent study, 28% of patients took 6 months or more to heal. Rotator cuff surgery has been demonstrated to be no more effective than PT and is associated with complications including retear, pain, and restriction in motion. Bone marrow-derived stem cells have been demonstrated to be effective in the treatment of rotator tears and without the risks, complications, and extensive downtime associated with surgery.
1.Huri G, Kaymakoglu M, Garbis N. Rotator cable and rotator interval: anatomy, biomechanics and clinical importance. EFORT Open Rev. 2019;4(2):56–62. Published 2019 Feb 20. doi:10.1302/2058-5241.4.170071
2. Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL. National trends in rotator cuff repair. J Bone Joint Surg Am. 2012;94(3):227–233
3.Houck DA, Kraeutler MJ, Schuette HB, McCarty EC, Bravman JT. Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses. Am J Sports Med. 2017;45(12):2911-5.DOI: 10.1177/0363546517692543
4. Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX. Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis. Arch Orthop Trauma Surg. 2014;134(9):1279-85.DOI: 10.1007/s00402-014-2028-2
5. Manaka, T., Ito, Y., Matsumoto, I. et al. Clin Orthop Relat Res (2011) 469: 1660. https://doi.org/10.1007/s11999-010-1689-6. doi: 10.1007/s11999-010-1689-6
6.Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil. 2017;39(14):1357-63.DOI: 10.1080/09638288.2016.1198431
7. Khatri C, Ahmed I, Parsons H, et al. The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis. Am J Sports Med. 2019;47(7):1734-43.DOI: 10.1177/0363546518780694
8.Jennifer C. Seida, MPH; Claire LeBlanc, MD; Janine R. Schouten, BSc; Shima S. Mousavi, MD; Lisa Hartling, PhD; Ben Vandermeer, MSc; Lisa Tjosvold, MLIS; David M. Sheps, MD, MSc. Systematic Review: Nonoperative and Operative Treatments for Rotator Cuff Tears. Annals of Internal Medicine. 17 August 2010.
11. Dezaly C, Sirveaux F, Philippe R, et al. Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term. Orthop Traumatol Surg Res. 2011;97(6 Suppl):S125-30.DOI: 10.1016/j.otsr.2011.06.006
12. Costa-Almeida R, Calejo I, Gomes ME. Mesenchymal Stem Cells Empowering Tendon Regenerative Therapies. Int J Mol Sci. 2019;20(12):3002. Published 2019 Jun 19. doi:10.3390/ijms20123002
13.Kim SJ, Kim EK, Kim SJ, Song DH. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res. 2018;13(1):1.DOI: 10.1186/s13018-017-0693-x
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