Recovery Timeline After Rotator Cuff Repair
Most patients achieve maximum recovery at 1 year postoperatively, with approximately 75% of pain relief and 50% of functional recovery occurring by 3 months, and 89% of pain relief with 81-88% of functional recovery by 6 months. 1
Expected Recovery Milestones
Early Recovery (0-3 Months)
- 74% of pain improvement is achieved by 3 months 1
- 45-58% of functional recovery occurs during this period 1
- Only 22% of elevation improvement is realized in the first 3 months 1
- 31% of patients achieve functional recovery (>80% on outcome scores) within 3 months 2
Intermediate Recovery (3-6 Months)
- 89% of pain improvement is achieved by 6 months 1
- 81-88% of functional recovery occurs by this timepoint 1
- 78% of elevation improvement is realized 1
- 40% of patients require 3-6 months to achieve functional recovery 2
Complete Recovery (6-12 Months)
- Maximum recovery plateau occurs at 1 year for pain, function, and motion 1
- 28% of patients require more than 6 months to achieve functional recovery 2
- Patient satisfaction exceeds 96% at all timepoints 1
Factors That Slow Recovery
Patient Factors
- Increasing age correlates with slower recovery and worse outcomes 3
- Shoulder stiffness at presentation significantly delays functional recovery 2
- Workers' compensation status correlates with less favorable outcomes 3
Tear Characteristics
- Larger tear size results in slower speed of recovery for function and range of motion 1
- Larger tears have lower motion and functional scores across all timepoints 1
- Fatty degeneration and muscle atrophy of supraspinatus and infraspinatus correlate with worse healing and outcomes 3
- Tear size does not influence pain levels 1
Postoperative Pain Management
Recommended Analgesic Protocol
Multimodal analgesia should include:
- Interscalene brachial plexus block (continuous or single-shot) as first-line regional anesthesia (Grade A) 3
- Intravenous dexamethasone perioperatively (Grade B) 3
- Paracetamol pre-operatively and postoperatively (Grade D) 3
- COX-2 inhibitor or NSAID pre-operatively and postoperatively (Grade D) 3
- Opioids for rescue only 3
- Suprascapular nerve block with or without axillary nerve block as alternative (not first choice, Grade B) 3
Rehabilitation Principles
Customized Approach Based on Risk
- Early overhead stretches (table slides) should begin immediately for patients at risk for stiffness 4
- Delayed overhead stretches until 6 weeks for remaining patients to avoid compromising repair integrity 4
- Gentle, chiefly passive rehabilitation is recommended to protect healing 5
- Arm kept in abduction postoperatively to reduce tension on repair 5
Critical Rehabilitation Goal
The best clinical results (strength, motion, pain relief) are achieved when durable tendon-to-bone healing occurs, making protection of the repair paramount during early recovery 4, 5
Healing and Long-Term Outcomes
- Intact cuff repairs demonstrate improved outcomes compared to re-tears at 2 years 3
- Tendon-to-bone healing correlates with better outcomes regardless of surgical technique 6
- Healing rates are inconsistent in elderly patients 3
- Factors predicting better healing include: age <65 years, recent tear, non-smoker, acromiohumeral distance >6mm, and Goutallier grade <2 5