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Systematic Reviews of Postoperative Rehabilitation to Optimize Patient Outcomes Following Common Sports Medicine Procedures

Svoboda, Steven J. MD; Attanasio, Sarah MS, ATC; Lincoln, Andrew ScD, MS

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Sports Medicine and Arthroscopy Review: June 2021 - Volume 29 - Issue 2 - p 53
doi: 10.1097/JSA.0000000000000316
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Nearly all surgical procedures in sports medicine are elective in nature and require a close relationship between orthopedic surgeons and physical therapists. There are virtually no surgical procedures for athletes that lead to an excellent outcome with high return to play rates without a significant commitment to postoperative rehabilitation. Postoperative rehabilitation plays major roles in protecting repairs and reconstructions, preserving range of motion, regaining strength, and achieving high levels of function at or near preinjury levels of sport performance for the injured athlete.

Postoperative rehabilitation is widely accepted within sports medicine, but there exists little consensus in the literature or among professional sports medicine associations regarding optimal rehabilitation protocols after common sports medicine surgeries. Most surgeons possess their own personal rehabilitation protocols that they provide to their patients after surgery to provide the guidelines for the patient’s physical therapists to follow through the process. While this is pragmatic given large health care networks, limitations by third party insurers, and patient preference, the wide variation among rehabilitation protocols presents risks to the optimal outcomes of patients given the variability in protocols presented to physical therapists from surgeons with varying training and experience.

In the interest of optimizing the outcomes of athletes after common sports medicine surgeries, we have assembled nationally renowned orthopedic sports medicine surgeons and physical therapists to approach the systematic review of ten common orthopedic sports medicine surgeries’ postoperative rehabilitation protocols. While a relatively straightforward task, the reader will find that a topic such as rotator cuff repair rehabilitation had over 4000 articles to initially review, while multiligament knee reconstruction had 216 articles to review. In total, contributing authors of the 10 chapters initially screened nearly 15,000 articles. Perhaps disappointingly, only ∼1% of these articles were of Level of Evidence (LOE) 1, 2, or 3 while the remaining articles were LOE 4 or 5.

We have sought to present the highest LOE in our systematic reviews to derive optimized, evidence-based rehabilitation protocols for each procedure as supplemental material. The reader is encouraged to utilize these rehabilitation protocols in their own practices with the hope that this can be a first step to having sufficiently high levels of evidence applied to rehabilitation protocols across our field. Each protocol provides a parenthetical reference to the highest LOE for each specific step of the protocol. This serves 2 purposes: first, to allow the reader to substitute portions of the protocol with their own preference for those situations where evidence is no better than expert opinion; second, to allow these protocols to act as starting points for future high-level research aimed at eliminating the knowledge gaps in sports medicine postoperative rehabilitation protocols. It is our hope that sports medicine patients benefit from these rehabilitation protocols and that this edition of Sports Medicine and Arthroscopy Reviews can serve as a starting point to optimizing the rehabilitation of all types of postsurgical rehabilitation protocols.

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