Kadir İlker YILDIZ, Turan Bilge KIZKAPAN

Artroskopik Rotator Manşet Onarımı Sonrası Rehabilitasyon Programlarının Zamanlama Açısından Karşılaştırılması

Amaç: Bu çalışmanın amacı, artroskopik rotator manşet onarımını (RMO) takiben hastalarda erken ve ertelemeli pasif eklem rehabilitasyon protokolünün fonksiyonel sonuçlar ve yaşam kalitesi üzerindeki etkilerini belirlemek ve karşılaştırmaktır. Gereç ve Yöntemler: Çalışmaya artroskopik RMO uygulanan toplam 202 hasta dahil edildi. Artroskopik RMO'dan hemen sonra rehabilitasyon programına başlayan 98 hasta erken rehabilitasyon (early rehabilitation, ER), ameliyat sonrası 3 hafta omuz eklem hareketine izin verilmeyen 104 hasta ise gecikmiş rehabilitasyon (delayed rehabilitation, DR) grubunu oluşturmaktaydı. Demografik özellikler, ameliyat öncesi ve ameliyat sonrası Amerikan Omuz ve Dirsek Cerrahları (American Shoulder and Elbow Surgeons, ASES) skoru, Sabit Murley (Constant Murley, CM) skoru, görsel analog skala (visual analogue scale, VAS) ve 36 maddelik Kısa Form Sağlık Anketi (SF-36) skorları değerlendirildi. Bulgular: Artroskopik RMO sonrası ASES, CM, VAS ve SF-36 skorlarının iyileşmesinde ER ve DR grupları arasında anlamlı bir fark saptanmadı. İki grup arasında takip süresince gelişen tekrar yırtık nüksü, donuk omuz ve enfeksiyon gibi komplikasyonlar açısından fark yoktu. Her iki rehabilitasyon protokolünün de hasta tarafından bildirilen sonuçlar üzerinde benzer bir etkiye sahip olduğu görüldü. Sonuç: Ortalama 13 aylık bir takip süresinde, erken ve gecikmiş başlangıçlı postoperatif rehabilitasyon programları, benzer fonksiyonel ve yaşam kalitesi sonuçları ve komplikasyon oranları ile ilişkilidir. Bu nedenle DR, özellikle büyük yırtıklara sahip hastalarda öncelikli olarak tercih edilebilir. ER, işe ve günlük hayata erken dönüş beklentisi olan küçük yırtıklara sahip hastalar için bir seçenek olabilir.

Anahtar Kelimeler:

Omuz, Artroskopi, Rotator manşet yaralanmaları, Rehabilitasyon

Comparison of Rehabilitation Programs After Arthroscopic Rotator Cuff Repair in Terms of Timing

Aim: The aim of this study was to determine and compare the effects of early and delayed passive joint rehabilitation protocol on functional and quality of life outcomes in patients following arthroscopic rotator cuff repair (RCR). Material and Methods: A total of 202 patients who underwent arthroscopic RCR were included into the study. Ninety eight patients who started the rehabilitation program just after the arthroscopic RCR were comprised as early rehabilitation (ER) group, while 104 patients whose shoulder joint motion was not allowed for 3 weeks after surgery as delayed rehabilitation (DR) group. Demographic characteristics, preoperative and postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant Murley (CM) score, visual analogue scale (VAS), and the 36-item Short Form Health Survey (SF-36) scores were evaluated. Results: There was no significant difference between the ER and the DR groups in terms of improvement of ASES, CM, VAS and SF-36 scores after arthroscopic RCR. There was no difference between two groups in terms of complications such as re-tear, frozen shoulder and infection that developed during the follow-up period. Both rehabilitation protocols were found to have a similar effect on patient-reported outcomes. Conclusion: At a mean follow-up time of 13 months, early and delayed onset postoperative rehabilitation programs are associated with similar functional and quality of life outcomes, and complication rates. Therefore, DR can be preferred primarily in patients with large tears. ER can be an option for the patients with small tears who has anticipation of early return to work and daily life.

Keywords:

Shoulder, Arthroscopy, Rotator cuff injuries, Rehabilitation,

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