Rotator Cuff Repair — Massive Tear with ECM Graft Reconstruction

UCLA Department of Orthopaedic Surgery - Sports Medicine · Thomas Kremen MD

Weight-Bearing

N/A (upper extremity)

Key Restrictions

Sling with abduction pillow at all times including sleep; sling removed for grooming/exercise; removed for desktop work after 2-3 wks with arm supported; wean after wk 4 in uncontrolled settings; full wean by wk 6; sling in public x 8 wks; no active UE on land x 8 wks; PROM: flexion 0-90° x 3 wks then 0-125° remainder of Phase 1; ER 0-40° x 3 wks then 0-60° (subscapularis repair: ER 30° x 3 wks then 45° x 3 more wks); no driving x 3 wks; no ROM behind back or cross body adduction past midline Phase 1; no pulleys Phase 1; aquatic therapy after 3 wks

Timeline & Phases

Phase 1 (day 1 - wk 8): sling with abduction pillow, no active UE on land, PROM in constraints (flex 0-90° x 3 wks → 0-125°; ER 0-40° x 3 wks → 0-60°), pendulum with 90° flexed elbow cradled by non-op arm, Grade I/II mobilization, aquatic therapy after 3 wks (slow motion, "don't let the water ripple"), no pulleys, no cross body adduction | Phase 2 (wks 8-12): D/C sling by wk 6 ("nothing heavier than coffee cup"), PROM toward full by wk 10, AAROM → AROM, ER at 90° abduction begins, rhythmic stabilization, aquatic therapy without ROM limits, submaximal isometrics, no pulleys until full PROM | Phase 3 (month 3-6): arm at/above shoulder height with light weight, lifting ≤10 lbs below shoulder; RC strengthening: IR/ER 30-50 reps low resistance, supine rhythmic stabilization → reclined → upright, palm-down scaption to 90° then overhead, scapular stabilization (serratus presses/wall presses on air disc/plyoball/incline), deltoid raises to 90°, gym machines anterior to body plane, PNF diagonals; advanced strengthening (surgeon clearance + 5-/5 cuff/scapular) for overhead athletes/heavy laborers

Notes

Specifically for massive rotator cuff tears reconstructed with ECM (extracellular matrix) graft; progression tailored to individual based on goals, age, tear size, degree of fatty infiltration, and repair tension; subscapularis repair modifier: ER PROM restricted to 30° x 3 wks then 45° x 3 additional wks; full wean from sling by wk 6 (vs wk 8 for pectoralis repair); PROM flexion starts at 0-90° (vs 0-140° for standard RCR Phase 1); no pulleys Phase 1; aquatic therapy at 3 wks; criteria to Phase 2: PROM goals, minimal pain; criteria to Phase 3: full PROM + AROM normalized mechanics + pain <2/10; no bathing until catheter removed from neck — shower with waterproof covering; RTS criteria: physician clearance, pain-free, sufficient ROM/strength; Kremen MD UCLA PatientPop practice site

Surgeon / Author

Thomas Kremen MD