Graft Jacket RTC Protocol
  • Sports Medicine

  • Knee Surgery

  • Shoulder Surgery

  • Elbow Surgery

  • Hip Surgery

  • Ankle Surgery

  • Arthroscopic Surgery

Graft Jacket RTC Protocol

Graft Jacket Rotator Cuff Reconstruction Protocol

Preoperative Goals

  • Full Range of motion
  • Normal Scapular/GH/Clavicular glides
  • 0 to minimal edema
  • Improve Peri-Scapular muscle strength
  • Independent in HEP

Treatment:

  • Modalities to reduce inflammation/pain(Vasopneumatic)
  • Grade 2, 3 mobilization GH, Scapula, Clavicle
  • ROM exercises Passive/Active Assist/Active (pendulums, cane exercises, pulley, wall slides)
  • Peri-Scapular muscle PRE’s(scapular retraction, gentle Theraband for retraction, extension, adduction, abduction)
  • Education in HEP/edema control
  • Post-operative Day of Surgery

Goal:

  • Control edema
  • Initiate elbow, wrist and hand and shoulder shrug exercises for early ROM
  • Use immobilizer all the time except for performing exercises, squeeze exercise ball as much as possible

PHASE I (Week 0-2)

  • Shoulder – Phase 1 home exercises
  • wrist, elbow and hand exercises
  • squeeze exercise ball as much as possible

PHASE Ia (Week 2-4)

  • Shoulder – PROM supine scapular plane
  • Codman pendulum exercises
  • Scapular mobilization
  • Flex: to tolerance 0 – 90 degrees
  • Abduction: 0 – 90 degrees
  • ER: 0 -30 degrees at modified neutral (do not stretch ER/IR) consider initiating pool where available
  • Extension and Horizontal Adduction: Avoid
  • Scapula – AROM scapular shrugs, scapular retraction, scapular depression
  • Elbow/Hand – AROM Flex/ext in neutral and hand strengthening

PHASE Ib(Week 4-6)

  • Shoulder – PROM (supine)
  • Flex: to tolerance 0 – 120 degrees
  • Abduction: maintain at 90 degrees until ER increases to 45 degrees then progress abduction to 120 degrees
  • ER: 0 – 45 degrees at modified neutral. Slowly increase abduction position during ER/IR to 80 – 90 degrees by 4 weeks. No aggressive stretching.
  • Be VERY cautious with IR to avoid tension on the Infraspinatus if repaired.
  • Ext and Horizontal Adduction: Avoid
  • Grade 1,2 GH mobilization in anterior, posterior, inferior directions for pain and spasms
  • Scapula – AROM scapular shrugs, scapular retraction, scapular depression.
  • Elbow/hand – Sub-max isometrics elbow flex/ext in neutral shoulder position

PHASE Ic(Week 6-8)

  • PROM (supine)
  • Flex: to tolerance 0 – 180 degrees or equal to uninvolved side
  • Abduction: 150 – 180 degrees w/ deviation toward scapular plane
  • ER: 70 – 90 degrees; IR: 40 – 60 degrees
  • Ext: 30 degrees without stretching, Horizontal Adduction: Avoid Supine stabilization exercises for the scapular muscles
  • Scapula – AROM scapular shrugs, scapular retraction, scapular depression
  • Elbow/Hand – Sub-maximal Isometric elbow flex/ext in neutral shoulder position
  • progress to gentle Isotonics:
  • 2-5 lb. BC curls and yellow Theraband Tricep pull-downs

PHASE II(Week 8-12)

  • Full ROM is allowed for PROM, AAROM, and AROM. Focus on proper technique and progress as tolerated.
  • No resistance exercises for the Rotator Cuff until week 14
  • Progress stabilization exercises to standing for the scapular muscles
  • Scapula – Peri-Scapular PRE’s(Rhomboids, Middle/Lower Trapezius, Lats, Serratus Anterior etc.)
  • Elbow/Hand – Progress to 6 lb curls and increase resistance w/ triceps pull-downs

PHASE III(Week 12 – 16)

  • Initiate light Rotator Cuff PRE’s (14 weeks)at 0 degrees abduction w/ Theraband and progress to moderate resistance
  • Progression of standing stabilization exercises
  • Progress Bicep/Tricep/Peri-Scapular strength/conditioning
  • Add PNF movements

PHASE IIII(Week 16-20)

  • Moderate Rotator Cuff PRE’s at 30 degrees abduction w/ Theraband and progress to high resistance at 60 degrees abduction
  • Progression of standing stabilization exercises
  • Progress Bicep/Tricep/Peri-Scapular strength/conditioning
  • Begin UBE
  • Begin closed chain stability exercises

PHASE V(Week 20-24)

  • High resistance Rotator Cuff PRE’s at 90 degrees abduction w/ Theraband
  • Begin plyometric exercises
  • Progression of standing stabilization exercises
  • Progress Bicep/Tricep/Peri-Scapular strength/conditioning
  • Progress UBE/closed chain stability exercises
  • Add gym exercises
  • Initiate sport specific training/job related tasks