Does application of abduction brace after arthroscopic rotator cuff repair improve blood flow around posterosuperior rotator cuff and repair site affecting pain level, clinical and structural outcome? A pilot randomized controlled trial

Abstract Background As per some cadaveric studies, blood flow in posterosuperior rotator cuff tendons improves in abducted shoulder position compared to neutral. In a clinical post rotator cuff repair scenario, the impact of abduction on altered blood flow in and around posterosuperior rotator cuff tendon over the clinical outcome and structural healing is unknown. Material and methods 42 eligible patients aged between 40 to 70 years with clinical and radiologically confirmed rotator cuff tear, who underwent arthroscopic rotator cuff repair, were included in the study. Patients were randomly allocated abduction brace (Group 1) or arm pouch (Group 2). Postoperative day 1, power Doppler scan was performed on index shoulder in adduction and 300 abduction for each patient, and then provided treatment arm as per group allotted. Power Doppler scan was repeated at six weeks in the position of immobilization advised to the patient (abduction or adduction). The vascular flow in six regions was noted as per Fealy’s criteria. Visual analog score (VAS) was assessed preoperatively, and at one, three, six, twelve and at 56 weeks postoperatively. Clinical assessment was performed using Constant Murley score at one year, and structural healing of cuff was assessed using ultrasonography at three and twelve months. Result On first postoperative day, the blood flow was significantly higher in all six areas of the shoulder in group 1 as compared to group 2. The mean total vascular score remained significantly higher in group 1 at postoperative day one (p=0.0001) and at six weeks (p=0.0001) compared to group 2. However, the significantly higher vascular flow was noted in peribursal region only at six week in group 1(p= 0.04). There was no significant difference noted in VAS score at any given point of follow-up between both the groups. Further, no clinical and structural healing difference was noted between both the groups at final follow-up. Conclusion Higher blood flow in and around posterosuperior rotator cuff due to abducted shoulder position with abduction brace in first six weeks fails to offer any advantage in terms of lower pain levels, better clinical score or superior healing of the cuff. Level of Evidence Level I; Randomized Controlled Trial; Treatment Study