What is a common postoperative protocol after rotator cuff repair?

• A. Early aggressive ROM
• B. Immobilization with no ROM for 6 weeks
• C. Immobilization with gradual progression from passive to active ROM and strengthening as healing allows
• D. Immediate strengthening

Answer: (C)

Protecting the repaired tendon during healing with a staged rehabilitation protocol is essential after rotator cuff repair. The goal is to balance protecting the repair with gradually restoring motion and strength as the tissue gains strength. Initially, immobilization limits stress on the tendon-bone junction, preventing strain that could loosen the repair. Then, the plan advances from passive or assisted ROM to active ROM as healing progresses, and finally to strengthening once the tissue can tolerate load. This approach minimizes the risk of re-tear while preventing stiffness. Early aggressive ROM or immediate strengthening would place excessive tensile forces on the healing tendon and increase the risk of failure, while prolonged immobilization without any motion can lead to stiffness and loss of mobility.