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The Effectiveness of CPM versus Accelerated Therapy Protocol

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Matt Ferlindes

on 1 May 2015

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Transcript of The Effectiveness of CPM versus Accelerated Therapy Protocol

The Effectiveness of CPM versus Accelerated Therapy Protocol in Decreasing Time Required for Return to Sport Following Bankart Lesion Repair
By: Kelsey Egger, Matt Ferlindes, Amanda Gumm, and Gregor Wenig
Research Question
In patients who had an arthroscopic glenolabral Bankart repair, does continuous passive motion (CPM), paired with traditional physical therapy, decrease time required to return to sport more than traditional physical therapy and accelerated therapy protocols?

Shoulder dislocations are common in athletics and often result in Bankart Lesions.
What are bankart lesions?
How are they repaired?

Physical therapy is often required following surgery.

CPM has become popular in early stages of therapy.
What is CPM?

Should CPM be utilized following a Bankart repair?

Rotator Cuff Tear Rehabilitation
Use of Early Motion (5, 6, 7, 8)
ROM (flexion and ER) and pain improvements in the short term vs. the long term
No greater risk of re-tear

CPM Use (4, 9, 10)
ROM and pain improvements at 3 months
ROM improvements extending to 6 months
Du Plessis et al. (10)
CPM in addition to PT had better pain, ROM, and strength outcomes in shorter amount of time
Improvements disappear at 6 months and 1 year
Theory Behind CPM Use
Low intensity force that puts stress on the tissues, which is thought to prevent joint stiffness (10)

Second order neurons in the dorsal horn become less sensitive to painful stimuli (11)
Rotator Cuff and Labrum
Work together to reinforce and provide stability to the glenohumeral (GH) joint (12)

Distal attachment of rotator cuff tendons fuses with the joint capsule (12)

Kinetic chain force transmission of extreme overhead upper extremity motions often seen in athletics (13)

Rotator cuff injuries often correlated to labral tears (14)
Kim et al. (3)
“Accelerated Rehab” group had improved pain
and returned to prior level of function faster than immobilization group
Did not have a greater chance at re-dislocation
Younger population
Glenoid Treatment and
Research Findings
Early Motion
Same Long Term Outcomes
Short Term Improvements

Clinical Importance
Younger, athletic population
PT Labor
Health Care System

Inclusion Criteria
Patients with a Bankart lesion caused by a first traumatic dislocation during an athletic performance, competition, or practice repaired by a suture anchor technique
Exclusion Criteria
Previous and additional shoulder complications
Age Range
18-40 years old
Power analysis requires N=60 subject to reach 80% power
All 3 groups will be compared for normal distribution of age, gender, and hand dominance

Kirkley et al. (17)
Surgery vs. Immobilization
Surgery = Better functional performance in a shorter amount of time with fewer re-dislocations
Use of surgery in a younger and more active population

Rehabilitation of Bankart Repair
Method of Group

Post surgery the attending nurse will open a random envelope with the random group assignment for the included subject

Informed Consent
Informed consent will be discussed and signed prior to surgery.
One PT will carry out the intervention.

A separate PT will assess the subjects’ ROM, pain, strength, and functionality
Every 2 weeks for the first 3 months
On the first of the month for the following 3 months

In the last 3 months: The same PT will record the amount of days to return to sport
One surgeon will assess when patients can return to sport
Both the PT doing the testing and the surgeon will be blinded to group assignment

Two Year Follow-Up: dislocation recurrence rate via self-reported log
Outcome Measures
Statistical Analysis
Primary Outcomes
Return to Sport
Recurrent Dislocations

Secondary Outcomes
Range of Motion

Alpha = 0.05

Two way ANOVA with repeated measures = pain, range of motion, and strength

One way ANOVA = number of days to return to sport and recurrent dislocations

Post hoc used to determine where difference occurs



Potential for attrition

Generalizability- Bankart lesion, athletes, age range
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