Rotator cuff repair may not negatively impact driving fitness
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CHICAGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed rotator cuff repair had no clinically significant negative impact on driving fitness.
Peter J. Apel, MD, and colleagues used an instrumented vehicle to obtain driving kinematics and behavioral data among 21 patients prior to rotator cuff repair and postoperatively at 2, 4, 6 and 12 weeks. Researchers evaluated parking, left and right turns, straightaways, yielding to oncoming traffic, highway merges, U-turns and traffic circles, as well as hand placement on the steering wheel, turn signal activation and use of overhead visor.
“We chose to look at this with a non-inferiority analysis to determine whether or not the patient’s driving fitness was non-inferior to the preoperative state,” Apel said in his presentation.
Results showed postoperative driving at 2 weeks was noninferior to preoperative driving on all kinematic metrics.
“What’s interesting is we noticed an adaptive behavior,” Apel said. “For example, for hand used, all of these patients drove with a sling, so if they had a left-sided rotator cuff tear, they used their left hand less. If they had a right-sided rotator cuff tear, they used their right hand less, and they also changed the position of where they put the hand on the steering wheel in order to maneuver.”
However, Apel noted patients perceived themselves as having a lower level of fitness earlier in their rehabilitation.
“[For] their overall perception of their driving performance, they thought they did worse at earlier time point, but our data showed otherwise,” Apel said.
Perspective
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The study by Ariel Badger, MS, and colleagues is well designed and executed. This investigation demonstrates that rotator cuff repair patients can safely and effectively drive during the early postoperative period despite inevitable pain, fatigue and restricted use of the affected extremity. Many surgeons, including myself, have been hesitant to allow patients to drive shortly after shoulder surgery both to protect them and, potentially, to mitigate legal risks if an untoward event occurs while a patient is behind the wheel. The authors should be credited for providing objective data that support vehicle driving recommendations for our patients during the early postoperative period. Certainly, the ability to drive within 2 weeks of undergoing shoulder surgery can simplify postoperative management and even potentially result in improved outcomes through greater access to physical therapy and other services. In addition, the ability of patients to have increased control of their postoperative rehabilitation is empowering for them and also reduces the burden on family and payers in support of patients’ recoveries..
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Tegge A, et al. Paper 375. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. March 22-26, 2022; Chicago.
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