Published 6/1/2008
Peter Pollack

Better to wedge cuff repairs

Derotation wedge may improve outcomes for smaller rotator cuff tears

Using a derotation wedge along with a simple sling after rotator cuff repair can result in significant improvement compared to using just a standard sling, especially for small and medium size tears. Gregory P. Nicholson, MD, presented these results at the 6th Biennial AAOS/American Shoulder and Elbow (ASES) Meeting.

The research team conducted a prospective, randomized study of 57 patients who underwent arthroscopic rotator cuff repair. Of those, 34 (60 percent) were treated with a sling and wedge, and 23 (40 percent) were treated with a sling only. The patients were randomized regardless of tear size or associated pathology; 34 tears were considered small or medium, and 23 were considered large or massive.

For the first 6 weeks after surgery, only pendulums, passive elevation, and external rotation were allowed. After 6 weeks, patients began active assisted range-of-motion (ROM) exercises and isometrics. At 3 months, active ROM and resistive exercises were allowed.

Noticing an immediate difference
At 1 week after surgery, the researchers found a significant difference between the two groups of patients. Patients treated with the sling and wedge averaged passive elevation of 94 degrees, while those treated only with the simple sling had an average of 75 degrees of passive elevation (p=0.02). The difference in passive external rotation was even more significant—26 degrees for patients with the sling and wedge vs. 12 degrees for patients with the sling only (p=0.001).

Superior (top) and frontal (bottom) views of a patient wearing the sling and wedge with a swathe around the torso. Patient had just undergone arthroscopic rotator cuff repair. Note the position of the forearm, and thus the shoulder, in neutral rotation.

At 3 months, passive external rotation remained significant, at 54 degrees for patients treated with the sling and wedge compared to 43 degrees for patients treated with the simple sling (p=0.05). But no significant differences between the two groups were found at 3 months or 6 months for active ROM, ASES or Simple Shoulder Test scores, or visual analog scale pain scores.

The authors did find that patients with small and medium rotator cuff tears who were treated with the sling and wedge showed significant improvement for longer periods. These patients also showed significant improvement in passive external rotation at the 1-month and 3-month follow-ups, and with active external rotation at the 3-month follow-up. Active forward elevation in these patients was also significantly better at 6 months; patients treated with a sling and wedge had active forward elevation of 175 degrees, compared to just 158 degrees for patients treated with the sling alone.

Because patients treated with a wedge and sling required less therapy effort in the early postoperative period, the authors noted that a potential contributor to repair failure may be minimized.

Working with Dr. Nicholson on the study were Matthew Nugent, MS; Anne Colton, MD; Stacy L. Twigg, PA-C; and Brice Blatz, MS.

Disclosure information on the authors can be found at www.aaos.org/disclosure

Peter Pollack is a staff writer for AAOS Now. He can be contacted at ppollack@aaos.org