The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an arthroscopic assisted/mini-open rotator cuff repair. It is by no means intended to be a substitute for one’s clinical decision-making regarding the progression of a patient’s postoperative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with Dr. Roe.
Progression to the next phase based on clinical criteria and/or time frames as appropriate
Phase I – Acute (0-6 weeks):
Goals:
- Protect repair, restore ambulation and ADL status.
- Weightbearing:
- 0-2 weeks: Partial weight-bearing.
- 2+ weeks: WBAT.
Brace and crutches:
- 0-1 week: Brace locked in full extension.
- 2-4 weeks: Open brace 60 degrees if good quad control.
- 4-6+ weeks: Open to full and discontinue when gait is normal.
Strengthening and conditioning:
- Quad sets, straight leg raises, single-leg balance, upper body ergometer, hip abduction strengthening.
Criteria for Phase Progression:
- Pain < 3/10 at worst.
- Within two degrees normal knee extension and 90 degrees knee flexion.
- Adequate single leg balance > 20s (firm ground).
- MD or PT approval.
Phase II – Strength (7-12 weeks):
Goal: Improved strength and initiate jogging program.
Range of motion:
- 6+ weeks - gradually progress flexion to full over the next four weeks.
Strengthening:
- Short arc leg press, step-ups, Romanian deadlifts (RDLs).
- Squat progression (bodyweight squats 🡪 single-leg squats).
- Resisted hip abduction, lateral band walks, core exercises (V-ups, single-leg bridging).
Conditioning:
- Stationary biking – initiated at 115 degrees of flexion.
- Elliptical and rowing machine after 10 weeks.
Criteria for jogging:
- At least 12 weeks post-op.
- Pain < 3/10 at worst.
- Within two degrees normal knee extension and 20 degrees knee flexion.
- At least one minute of single-leg squats.
- MD or PT approval.
Phase III – Agility (12-16 weeks):
Goal: Introduced dynamic and power movements.
Strengthening:
- Gym-specific strengthening (barbell squats and deadlifts).
- Biodex quad and hamstring fatiguing protocols.
- Core exercises (mountain climbers, V-ups).
Conditioning:
- Road or stationary biking.
- Jogging program.
- Swimming (progress kicking gradually and pain-free).
Plyometrics and light agility:
- Ladder drills, box jumps (up to 12”), side shuffle.
Criteria for heavy agility and sport-specific movements:
- 16 weeks post-op.
- Pain < 2 at worst.
- Quad and HS strength > 80% normal; >50% H/Q ratio for females.
- At least two minutes of single-leg squats (resisted).
- <5 on landing error scoring system (LESS).
- MD or PT approval.
Phase IV – Return to play (16-20+ weeks):
Goal: Initiate sport-specific movements and return to play.
Strengthening:
- Progress gym routine (squats, deadlifts, with peak lifting).
- Biodex quad and hamstring fatiguing protocols and core exercises.
Conditioning:
- Jogging, biking, swimming.
- Interval sprint workouts.
Plyometrics and agility:
- Max effort box jumps (progression with rotation.
- Lateral and rotational agility.
- Single leg hops.
- Unpredictable cutting and contact drills.
Criteria for return to play:
- Pain < 2 at worst.
- Quad and HS strength > 90% normal; >60% H/Q ratio for females.
- At least 3 minutes of single-leg squats (resisted).
- 90% normal in all single-leg hop test.
- 95% normal figure-of-eight, 5-10-5 agility, single-leg vertical jump.
- MD or PT approval.