Why healing matters more than the repair itself
A successful rotator cuff repair requires healing to occur between the tendon and the bone. At the time of surgery the tendon is reattached to the bone, and immediately afterwards a thin layer of clot forms between the two. Everything that follows is biology rather than surgery, which is why the timeframes in your rehabilitation programme are not arbitrary.
The first few weeks: laying down collagen
Fibroblasts, a type of cell, migrate from the bloodstream into the clot and begin to deposit collagen. Collagen is the main component of tendons and ligaments. The collagen laid down early is deposited in a disorganised pattern, and most of this deposition occurs in the first 4 to 6 weeks.
At this stage the attachment has very little strength of its own, which is why a sling is needed and why active use of the arm is restricted.
Weeks 4 to 12: remodelling
The disorganised collagen fibres then realign themselves into parallel bundles, and strength returns to the connection between tendon and bone. Remodelling is a slow process overall, but it is fastest between weeks 4 and 12.
Months 4 to 12: continued gains
Remodelling continues for at least 6 to 12 months, slowing down over time. The majority of it is complete by 4 to 6 months. The strength of the attachment between tendon and bone keeps improving for at least the first 12 months after surgery.
This is the part that most often surprises people. Your shoulder is still getting stronger long after it has stopped feeling like it is recovering.
How rehabilitation fits in
Light loading of the shoulder and light physiotherapy exercises stimulate remodelling. This is the reason rehabilitation is introduced gradually rather than all at once: too little movement risks stiffness, while too much load too early risks the repair. Your programme is written around the operation you have had, so please follow the one your physiotherapist has given you.
Related pages
The exercise videos are indexed on the rehabilitation page.
These instructions are general guidance for patients of Dr Kenneth Cutbush. Your own instructions may differ depending on your procedure. Always follow the advice given to you by Dr Cutbush and your physiotherapist. If something does not look or feel right, contact the rooms on (07) 3063 5500.
