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Rehabilitation & Recovery

Post-operative foot/ankle & upper extremity rehab: principles of early mobilization, protocol variability, and functional outcome optimization.

Overview

Current evidence indicates a lack of consensus regarding the definition of accelerated rehabilitation and the selection of outcome measures following traumatic anterior shoulder dislocation [1]. While aggressive rehabilitation protocols after arthroscopic rotator cuff repair demonstrate trends toward improved early range of motion, pain relief, and outcome scores, no definitive consensus supports a clinical difference based on rehabilitation timing in the early healing stages [2]. For massive rotator cuff repairs, home-based rehabilitation yields functional scores and healing rates largely similar to supervised physical therapy at latest follow-up [3].

Rehabilitation strategies vary by pathology but consistently aim to maximize recovery. In proximal humerus fractures, compliance predicts short-term outcomes up to 3 months and potentially 1-year outcomes [4]. Postoperative rehabilitation is essential for maximizing functional recovery and patient-reported outcomes in hand transplantation [5]. For Achilles tendon reconstruction, ultrasound integration in rehabilitation algorithms creates optimal conditions for functional recovery [7], while rehabilitation benefits recovery after cervical and lumbar spine surgery, though further investigation is needed to standardize approaches [10]. Gamification with remote monitoring produces range of motion and patient-reported outcomes equivalent to conventional protocols after arthroscopic shoulder surgery [13], and home-based neuromuscular electrical stimulation offers a safe adjunct for rapid functional restoration following arthroscopic rotator cuff repair [15].

For spinal cord injury, rehabilitation approaches facilitate community reintegration [12]. Future emphasis in hip rehabilitation should focus on critical appraisal of nonsurgical treatment, postoperative protocols, and return-to-play considerations [17]. Guidelines for reverse total shoulder replacement specifically aim to achieve optimal pain relief, maximize functional outcomes, and mitigate surgical risks [20].

Anatomy & Pathophysiology

Kinematics and Gait

Surgical correction of clubfoot via the Ponseti method achieves a plantigrade foot in 95% of initially untreated cases, though residual deformities remain common [24]. Both nonoperatively and surgically treated clubfeet exhibit significant limitations in ankle plantar flexion, resulting in decreased range of motion, moment, and power compared with controls [69]. In adult footdrop, surgical deformity correction combined with tendon transfers restores near-normal gait with notable success, yet limitations and postoperative dorsiflexion weakness persist [75]. Following acute Achilles tendon rupture repair, increased knee flexion serves as a compensatory strategy for decreased ankle plantarflexion [54]. Females perceive more functional limitations than males one year post-rupture, whereas smokers experience fewer limitations [67]. Hallux valgus deformity severity correlates positively with the magnitude of anteroposterior postural sway [65].

Osseous and Joint Pathology

Resection of talocalcaneal coalition fails to restore normal function, as evidenced by persistent gait analysis abnormalities [68]. Calcaneal lengthening osteotomy in ambulatory patients with cerebral palsy and planovalgus foot deformity demonstrates a tendency toward overcorrection, indicated by increased pressure exerted on the lateral midfoot [60]. Rigid flatfoot deformities in adolescents present a less predictable clinical course and are associated with various underlying causes [73].

Classification

Rehabilitation Consensus & Definitions: There is no consensus on the definition of accelerated rehabilitation following traumatic anterior shoulder dislocation [1], nor on outcome measure selection for post-operative rehabilitation following traumatic anterior shoulder dislocation [1]. Similarly, early functional rehabilitation for acute Achilles tendon rupture lacks a standardized definition, resulting in highly variable interventions and outcome measures [11]. Consequently, pooling data across studies on early functional rehabilitation for acute Achilles tendon rupture requires attention to specific intervention inclusions and assessment methods [11].

Rotator Cuff Repair Protocols: No definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing after arthroscopic rotator cuff repair [2]. However, some studies report trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation following arthroscopic rotator cuff repair [2]. Recovery speed varies by tear size, with larger rotator cuff tears demonstrating a slower speed of recovery following arthroscopic repair [6]. At 3 months following arthroscopic rotator cuff repair, approximately 75% of pain relief can be expected [6], while approximately 50% of functional recovery can be expected [6].

Supervision & Modality Selection: Patients undergoing home-based rehabilitation after massive rotator cuff repair showed largely similar functional scores and healing to those with supervised physical therapy at the latest follow-up [3]. The selection of specific therapeutic modalities is based on their efficacy during a particular phase of rehabilitation [22]. The use of an original algorithm of rehabilitation protocol with ultrasound creates good conditions for optimal functional recovery in Achilles tendon reconstruction cases [7].

Joint Arthroplasty & Discharge Factors: Substantial changes in discharge to rehabilitation are associated with declines in average functional outcomes, the extent of therapy received, and health-related quality-of-life following Medicare Total Hip Arthroplasty/Total Knee Arthroplasty bundled payments [9]. A comprehensive five-phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement provides a framework where progression from surgery to increasing post-operative activity level can take place in a predictable manner [43].

Neurologic & Complex Injury Rehabilitation: Rehabilitation for spinal cord-injured patients involves prognosticating neurologic recovery, managing secondary complications, utilizing contemporary rehabilitation approaches to maximize function, and facilitating reintegration into the community [12]. Advances in rehabilitation of combat-related extremity injuries have yielded substantial improvement in recovery of function, management of chronic pain, and the reintegration of wounded warriors into society [27]. The use of serious games combined with conventional physical therapy intervention played a fundamental role in recovery and return to work activities after complex fracture of the wrist [42], as well as in the recovery of general health condition after complex fracture of the wrist [42].

General Principles & Systems: Rehabilitation involves care of the injured person with either neurologic or musculoskeletal problems and focuses on improving function through surgical and nonsurgical management [28]. It is recognized as an important part of the care of acute problems [28] and chronic problems [28]. The Systems model is used to guide the interpretation of how learning or re-learning movement occurs in upper extremity rehabilitation [40]. Effective rehabilitation treatments have the potential to effect change in current clinical practice for postoperative management of lumbar spine surgery [41].

Clinical Presentation

Consensus regarding the definition of accelerated rehabilitation and the selection of outcome measures following traumatic anterior shoulder dislocation remains absent [1]. Similarly, early functional rehabilitation for acute Achilles tendon rupture lacks a standardized definition, with interventions and outcome measures exhibiting high variability [11]. In the context of arthroscopic rotator cuff repair, no definitive consensus supports a clinical difference resulting from rehabilitation timing in early healing stages, though some studies report trends toward improved early range of motion, pain relief, and outcome scores with aggressive protocols [2].

Prognostic factors for response to physiotherapy in musculoskeletal shoulder pain include baseline pain severity, baseline disability, and psychological factors, though the evidence quality regarding these factors is generally low [31]. Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach for the painful shoulder, while a comprehensive evaluation approach prior to and throughout treatment assists clinicians in selecting appropriate treatments based on patient need [32]. Rehabilitation is a valuable intervention specifically for atraumatic posterior shoulder subluxation [30].

Recovery trajectories vary significantly by pathology and procedure. At three months following arthroscopic rotator cuff repair, approximately 75% of pain relief and 50% of functional recovery can be expected, with larger tears demonstrating a slower speed of recovery [6]. Reverse total shoulder replacement yields a slower recovery at three months compared to internal fixation for geriatric three- and four-part proximal humerus fractures, yet appears to yield a better outcome at two years [21]. Recovery from low back pain at six months remains low at 12.6% [19].

Rehabilitation compliance predicts short-term clinical outcomes up to three months for proximal humerus fractures and potentially predicts one-year clinical outcomes [4]. For total hip and knee arthroplasty, substantial changes in discharge to rehabilitation are associated with declines in average functional outcomes, the extent of therapy received, and health-related quality of life [9]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Contemporary rehabilitation approaches for spinal cord-injured patients focus on prognosticating neurologic recovery, managing secondary complications, and utilizing approaches to maximize function and facilitate reintegration into the community [12]. Rehabilitation benefits patients after cervical and lumbar spine surgery, though further investigation is needed to achieve a standardized approach [10]. Outcomes judged by range of motion and patient-reported outcome measures for gamification with remote monitoring are equivalent to conventional physiotherapy rehabilitation protocols after arthroscopic shoulder surgery [13].

Therapeutic home-based neuromuscular electrical stimulation offers a safe adjunctive strategy for early rehabilitation following arthroscopic rotator cuff repair, particularly suited to patients requiring rapid functional restoration [15]. Patients undergoing home-based rehabilitation after massive rotator cuff repair showed largely similar functional scores and healing to those with supervised physical therapy at the latest follow-up [3]. Improvement in outcomes for rotator cuff tears was observed up to 16 sessions of physical therapy, after which outcomes plateaued [8]. An ultrasound-based rehabilitation algorithm creates good conditions for optimal functional recovery in Achilles tendon reconstruction cases [7].

Investigations

Other Considerations: Consensus on the definition of accelerated rehabilitation and outcome measure selection following traumatic anterior shoulder dislocation is currently lacking [1]. No definitive consensus exists regarding a clinical difference resulting from rehabilitation timing in the early stages of healing after arthroscopic rotator cuff repair, though some studies report trends toward improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation [2]. For massive rotator cuff repairs, home-based rehabilitation yields largely similar functional scores and healing to supervised physical therapy at the latest follow-up [3]. Recovery timelines vary by pathology; at 3 months post-arthroscopic rotator cuff repair, approximately 75% of pain relief and 50% of functional recovery are expected, with larger tears recovering more slowly than smaller ones [6]. In reverse total shoulder replacement (rTSA) for geriatric three- and four-part proximal humerus fractures, recovery is slower at 3 months compared to internal fixation, though rTSA yields better outcomes at 2 years [21]. Following distal radius fracture, functional recovery reaches population normal levels for range of motion, grip strength, and QuickDASH scores a decade post-injury, regardless of radiological outcomes [26].

Rehabilitation protocols for other pathologies show specific monitoring and timing requirements. Ultrasound-monitored algorithms for Achilles tendon reconstruction create optimal conditions for functional recovery, and ultrasonography monitoring may optimize early recovery in young, high-demand athletes after Achilles rupture repair [7, 55]. Physical therapy for rotator cuff tears improves outcomes up to 16 sessions, after which results plateau [8]. For cervical and lumbar spine surgery, rehabilitation offers benefits but requires further investigation to standardize approaches [10]. Low back pain recovery at 6 months remains low at 12.6% [19]. Return to sport criteria for osteochondritis dissecans of the capitellum consistently include the return of elbow range of motion and healing demonstrated on postoperative imaging [56]. Nerve transfers for elbow flexion restoration are recommended for acute flaccid myelitis patients failing to improve clinically after 6 to 9 months of incomplete recovery [57]. Regarding coracoclavicular ligament reconstruction, return to activity does not correlate with radiographic maintenance of reduction, suggesting activity is a more clinically relevant outcome measure [62]. Early return to play for Jones fractures prior to full radiological union is not advised due to refracture risk [63]. Post-arthroscopic capsular release for adhesive capsulitis shows immediate improvements in pain and function that continue to progress at 6, 12, and 24 weeks [66].

MRI: Imaging provides critical data on tissue regeneration and healing status. MRI demonstrates complete regeneration of subchondral bone and cartilage in patients with Hepple Stage V osteochondral lesions of the talus treated with a platelet-rich plasma scaffold, correlating with significant functional score improvements [34]. Following hamstring harvest for ACL reconstruction, tendon regeneration is frequently observed on MRI at 6 months; however, knee flexion strength deficits at this time point are similar across regeneration groups and graft types, and strength recovery does not correlate with radiological tendon regeneration [45]. Despite these findings, hamstring muscle strength recovery remains incomplete at 2 years post-harvest [45].

Other Considerations: Adjunctive therapies show mixed results. Image-guided PRP treatment administered on two occasions does not improve early tendon-bone healing or functional recovery after arthroscopic supraspinatus repair [52].

Treatment

Non-Operative

Conservative management remains a viable option for specific pathologies, such as clavicular fractures where athletes returned to sport 40% faster than surgical cohorts, though this advantage may be confounded by the severity and complexity of fractures treated surgically [51]. For non-surgically managed proximal humerus fractures, commencement of mobilisation within one week from injury is safe and may confer short-term functional benefits compared to delayed mobilisation [44]. In adhesive capsulitis, surgery ranks highest across all range of motion domains only after the failure of conservative treatment [46]. For acute low back pain, prognostic models containing partially different predictors were developed with acceptable performance for predicting recovery in patients consulting a physiotherapist, outperforming current practice [49].

Operative

Indications: Surgical management is valuable after the period of spontaneous neurologic recovery in stroke patients to release muscle spasticity, manage painful contractures, and position the extremity functionally [25]. Open repair produces superior results compared with conservative treatment for first-time traumatic anterior dislocation of the shoulder, with significantly lower recurrence rates and better long-term outcomes [50].

Rehabilitation Protocols: There is no consensus on the definition of accelerated rehabilitation or outcome measure selection for post-operative rehabilitation following traumatic anterior shoulder dislocation [1]. No definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing for arthroscopic rotator cuff repair, despite some studies reporting trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation [2]. An accelerated rehabilitation protocol after matrix-induced autologous chondrocyte implantation is safe and effective, providing comparable, if not superior, clinical outcomes to patients throughout the postoperative timeline [14]. A recurrence rate of 9% was observed following accelerated rehabilitation after arthroscopic Bankart repair in professional footballers, which compares favourably to other published studies employing more conservative postoperative rehabilitation regimes [16]. Rehabilitation guidelines for reverse total shoulder replacement aim to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery [20].

Adjuncts: Home-based neuromuscular electrical stimulation offers a safe adjunctive strategy for early rehabilitation following arthroscopic rotator cuff repair, particularly suited to patients requiring rapid functional restoration [15]. The use of ultrasound in a rehabilitation protocol creates good conditions for optimal functional recovery in Achilles tendon reconstruction cases [7]. Outcomes judged by range of motion and patient-reported outcome measures are equivalent between gamification with remote monitoring and conventional physiotherapy rehabilitation protocols for patients after arthroscopic shoulder surgery [13].

Outcomes and Compliance: Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5]. At 3 months following arthroscopic rotator cuff repair, approximately 75% of pain relief and 50% of functional recovery can be expected, with larger tears having a slower speed of recovery [6]. Improvement in outcomes was observed up to 16 sessions of physical therapy for rotator cuff tears, after which outcomes plateaued [8]. Rehabilitation compliance predicts short-term clinical outcomes up to 3 months and potentially 1-year outcomes for proximal humerus fractures [4]. Substantial changes in discharge to rehabilitation are associated with declines in average functional outcomes, extent of therapy received, and health-related quality-of-life [9]. Patients should be encouraged to continue strengthening exercises well after the initial recovery period following brachial plexus reconstruction [33].

Standardization and Scope: Rehabilitation has benefits on the recovery of patients after spine surgery, but further investigation is needed to achieve a standardized rehabilitation approach [10]. There was a lack of published protocols and enough variability in rehabilitation protocols after lateral ankle ligament surgery that the need for standardization was shown [29]. Future emphasis in hip rehabilitation should be placed on critical appraisal of nonsurgical treatment, postoperative rehabilitation protocols, and return-to-play considerations [17]. An international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria [47]. Rehabilitation involves care of the injured person with either neurologic or musculoskeletal problems, focusing on improving function through surgical and nonsurgical management and is recognized as an important part of the care of both acute and chronic problems [28]. The selection of specific therapeutic modalities is based on their efficacy during a particular phase of rehabilitation [22].

Complications

Stiffness / Arthrofibrosis: The definition of accelerated rehabilitation and selection of outcome measures following traumatic anterior shoulder dislocation lack consensus [1]. For acute Achilles tendon rupture, the absence of a standardized definition for early functional rehabilitation has resulted in highly variable interventions and outcome measures [11]. While manipulative therapy combined with usual medical care accelerates recovery for shoulder complaints compared to usual care alone, it is associated with higher costs [35]. In rotator cuff tear management, improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued [8].

Rehabilitation Timing and Modality: No definitive consensus supports a clinical difference resulting from rehabilitation timing in the early stages of healing after arthroscopic rotator cuff repair, despite some studies reporting trends in improved early range of motion, pain relief, and outcome scores with aggressive rehabilitation [2]. Patients undergoing home-based rehabilitation protocols showed largely similar functional scores and healing to those with supervised physical therapy after arthroscopic rotator cuff repair of massive tears at the latest follow-up [3]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Fracture and Arthroplasty Outcomes: Rehabilitation compliance predicts short-term clinical outcomes up to 3 months and potentially 1-year outcomes for proximal humerus fractures [4]. However, substantial changes in discharge to rehabilitation were associated with declines in average functional outcomes, extent of therapy received, and health-related quality-of-life following Medicare Total Hip Arthroplasty/Total Knee Arthroplasty bundled payments [9]. Patients discharged to a rehabilitation program after femoral neck or intertrochanteric fracture were more likely to have at least one inpatient medical complication than patients who were not discharged to this program [36]. Furthermore, these patients were less likely to have recovered their prefracture level of independence in basic activities of daily living at the three-month follow-up evaluation than patients who were not discharged to this program [36].

Other Considerations: Advances in rehabilitation of combat-related extremity injuries have yielded substantial improvement in terms of recovery of function, management of chronic pain, and the reintegration of wounded warriors into society [27].

Recovery

Light activity (weeks): Evidence regarding specific timelines for light activity, such as desk work or driving, is not explicitly defined in the provided literature. However, patients undergoing rehabilitation using a home-based protocol demonstrated functional scores similar to those with supervised physical therapy after arthroscopic rotator cuff repair of massive tears at the latest follow-up [3]. Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in hand transplantation [5].

Full activity (months): At 3 months following arthroscopic rotator cuff repair, approximately 75% of pain relief and 50% of functional recovery can be expected [6]. Larger tears have a slower speed of recovery following arthroscopic rotator cuff repair [6]. Improvement in outcomes was observed up to 16 sessions of physical therapy for rotator cuff tears, after which outcomes plateaued [8]. A recurrence rate of 9% was observed following accelerated rehabilitation after arthroscopic Bankart repair in professional footballers, which compares favorably to studies employing more conservative postoperative rehabilitation regimes [16].

Complete recovery / outcome plateau (months): Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy for osteonecrosis of the femoral head, though physical recovery requires an extended duration [37]. Benefits of sensory-motor rehabilitation therapy for task-specific focal hand dystonia can be sustained over a seven-year follow-up [39]. Substantial changes in discharge to rehabilitation are associated with declines in average functional outcomes, extent of therapy received, and health-related quality-of-life [9].

Rehabilitation protocol: There is no consensus on the definition of accelerated rehabilitation or outcome measure selection following traumatic anterior shoulder dislocation [1]. No definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing for arthroscopic rotator cuff repair, despite some studies reporting trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation [2]. Because early functional rehabilitation for acute Achilles tendon rupture has lacked a standardized definition, interventions and outcome measures are highly variable [11]. An accelerated rehabilitation protocol after matrix-induced autologous chondrocyte implantation is safe and effective, providing comparable, if not superior, clinical outcomes to traditional approaches throughout the postoperative timeline [14]. Successful management of rotator cuff disease is dependent on appropriate rehabilitation based on an evaluation of underlying tissue quality and structural integrity rather than solely on empirical clinical experience or fixed healing timelines [64].

Functional milestones: Rehabilitation compliance predicts short-term clinical outcomes up to 3 months and potentially 1-year outcomes for proximal humerus fractures [4]. Functional ability and health-related quality of life improved after a structured national rehabilitation program for patients with musculoskeletal disorders [18]. A therapeutic framework for continued upper limb rehabilitation in patients' own environment can maximize functional recovery in individuals long after their stroke [23]. Patients are interested in the timeline of recovery, ability to perform specific activities after surgery, and short-term and long-term restrictions following reverse total shoulder arthroplasty [48].

Other Considerations: A plantigrade foot was achieved in 95% of feet initially and was maintained in most patients following the Ponseti method for untreated clubfeet, although residual deformities were common [24].

Key Evidence

  • [L4] There is no consensus on the definition of accelerated rehabilitation or outcome measure selection. (10.1177/17585732221089636)
  • [L4] Although some studies report trends in improved early range of motion, pain relief, and outcomes scores with aggressive rehabilitation, no definitive consensus exists supporting a clinical difference resulting from rehabilitation timing in the early stages of healing. (10.5435/jaaos-22-01-1)
  • [L3] Patients undergoing rehabilitation using a home-based protocol showed largely similar functional scores and healing to those with supervised PT after ARCR of MRCTs at the latest follow-up. (10.1016/j.arthro.2024.06.037)
  • [L2] Rehabilitation compliance predicts short-term clinical outcomes up to 3-months and potentially 1-year outcomes. (10.1186/s12891-023-06894-w)
  • [L4] Postoperative rehabilitation is essential to maximize functional recovery and patient-reported outcomes in HT. (10.1177/15589447221124250)
  • [L4] At 3 months, approximately 75% of pain relief and 50% of functional recovery can be expected, with larger tears having a slower speed of recovery. (10.1016/j.jse.2016.11.002)
  • [L4] This approach creates good conditions for the optimal functional recovery. (10.1177/2325967114s00167)
  • [L3] Improvement in outcomes was observed up to 16 sessions of physical therapy, after which outcomes plateaued. (10.1016/j.jse.2018.10.001)
  • [L4] The results demonstrate substantial changes in discharge to rehabilitation with accompanying declines in average functional outcomes, extent of therapy received, and health-related quality-of-life. (10.1016/j.arth.2019.01.068)
  • [L4] Rehabilitation has benefits on the recovery of patients after spine surgery, but further investigation is needed to achieve a standardized rehabilitation approach. (10.1530/eor-23-0015)
  • [L4] Because early functional rehabilitation has lacked a standardized definition, interventions and outcome measures are highly variable, and pooling data across studies should be done with attention paid to what was included in the intervention and how treatment was assessed. (10.1177/2325967119884071)
  • [L5] The purpose of this review article is to provide a surgeon's perspective on prognosticating neurologic recovery, managing secondary complications, and utilizing contemporary rehabilitation approaches to maximize function and facilitate reintegration into the community for spinal cord-injured patients. (10.5435/jaaos-d-18-00559)
  • [L2] Outcomes, judged by ROM and patient-reported outcome measures, are equivalent to conventional physiotherapy rehabilitation protocols. (10.1016/j.jse.2021.08.019)
  • [L1] The outcomes of this randomized trial demonstrate a safe and effective accelerated rehabilitation protocol as well as a regimen that provides comparable, if not superior, clinical outcomes to patients throughout the postoperative timeline. (10.1177/0363546512445167)
  • [L1] This intervention offers a safe adjunctive strategy for early rehabilitation, particularly suited to patients requiring rapid functional restoration. (10.1186/s12891-025-09030-y)
  • [L4] A recurrence rate of 9% compares favourably to other published studies following similar surgery but which employed more conservative postoperative rehabilitation regimes. (10.1177/1758573216647898)
  • [L3] Functional ability and health related quality of life improved after rehabilitation. (10.1186/1471-2474-14-57)
  • [L2] Recovery from low back pain at 6 months was low (12.6%). (10.1186/s12891-015-0509-2)
  • [L5] The review outlines rehabilitation guidelines developed to manage patients who have undergone reverse total shoulder replacement, aiming to achieve optimal pain relief and maximize functional outcomes while mitigating risks associated with the surgery. (10.1111/j.1758-5740.2011.00138.x)
  • [L3] rTSA appears to yield a slower recovery at 3 months but a better outcome at 2 years. (10.1186/s12891-023-06669-3)
  • [L5] The selection of specific therapeutic modalities is based on their efficacy during a particular phase of rehabilitation. (10.5435/jaaos-d-15-00348)
  • [L5] These themes suggest a therapeutic framework for continued upper limb rehabilitation in patients' own environment to maximize functional recovery in individuals long after their stroke, and generate hypotheses which may lead to the development of new therapeutic protocols. (10.1016/j.jht.2012.08.002)
  • [L4] A plantigrade foot was achieved in 95% of the feet initially and was maintained in most of the patients, although residual deformities were common. (10.2106/jbjs.18.00445)
  • [L5] Surgical management is valuable after the period of spontaneous neurologic recovery to release muscle spasticity, manage painful contractures, and position the extremity functionally. (10.5435/00124635-200808000-00005)
  • [L2] A decade after the injury event, range of motion, grip strength and QuickDASH were recovered to population normal, regardless of radiological outcomes. (10.1177/17531934231194682)
  • [L5] Advances made during the past 10 years in rehabilitation of combat-related extremity injuries have yielded substantial improvement in terms of recovery of function, management of chronic pain, and the reintegration of wounded warriors into society. (10.5435/jaaos-20-08-s80)
  • [L4] There was a lack of published protocols and enough variability that the need for standardization of rehabilitation protocols was shown. (10.1016/j.arthro.2020.12.153)
  • [L4] These results support the view that rehabilitation is a valuable intervention when faced with such a patient presentation. (10.1177/1758573213517218)
  • [L2] The review identified several prognostic factors for response to physiotherapy, including baseline pain severity, disability, and psychological factors, though the evidence quality was generally low. (10.1186/1471-2474-14-203)
  • [L5] Combining pathoanatomic causes with movement impairments provides a more focused rehabilitation approach, and applying a comprehensive evaluation approach prior to and throughout treatment can assist clinicians in selecting appropriate treatments based on patient need. (10.1016/j.jse.2023.07.013)
  • [L4] Patients should be encouraged to continue strengthening exercises well after the initial recovery period. (10.1016/j.jhsa.2015.11.010)
  • [L4] MRI demonstrated complete regeneration of subchondral bone and cartilage in all patients with significant improvement in functional scores. (10.1155/2017/6525373)
  • [L1] Manipulative therapy in addition to usual medical care accelerates recovery and is more effective than usual medical care alone on the long term, but is associated with higher costs. (10.1186/1471-2474-11-200)
  • [L3] Patients discharged to the rehabilitation program were more likely to have at least one inpatient medical complication and were less likely to have recovered their prefracture level of independence in basic activities of daily living at the three-month follow-up evaluation than patients who were not discharged to this program. (10.2106/00004623-199803000-00008)
  • [L3] Significant improvements in quality of life and functional capabilities can be achieved following femoral osteotomy, though physical recovery requires an extended duration. (10.1016/j.arth.2025.06.066)
  • [L4] Benefits of sensory-motor rehabilitation can be sustained. (10.1016/j.jht.2025.02.008)
  • [L5] The article provides a review of motor control and learning principles, emphasizing the Systems model to guide the interpretation of how learning or re-learning movement occurs in upper extremity rehabilitation. (10.1016/j.jht.2012.12.007)
  • [L2] The authors state that effective rehabilitation treatments will have the potential to effect change in current clinical practice. (10.1186/1471-2474-15-325)
  • [Case_report] The use of serious games combined with a conventional physical therapy intervention played a fundamental role in recovery and return to work activities, and there was also an important recovery of general health condition. (10.1016/j.jht.2018.11.003)
  • [L4] This five-phase rehabilitation programme provides a framework where progression from surgery to increasing post-operative activity level can take place in a predictable manner. (10.1007/s00167-013-2664-z)
  • [L1] Our meta-analysis of RCTs showed that commencement of mobilisation within one week from injury for non-surgically managed PHFs is safe and may confer short-term functional benefits compared to delayed mobilisation. (10.1186/s12891-025-08371-y)
  • [L2] Tendon regeneration was frequently observed on MRI at 6 months, but knee flexion strength deficits were similar across regeneration groups and graft types. (10.1002/ksa.70346)
  • [L1] Surgery (after failure of conservative treatment) ranked highest across all ROM domains. (10.1016/j.arthro.2020.09.041)
  • [L1] This international EU–US consensus established recommendations for prevention strategies, describes rehabilitation of non-operated patients and of patients after partial meniscectomy, meniscus repair and meniscus reconstruction, and establishes return to sport criteria. (10.1002/ksa.12689)
  • [L4] Patients are interested in the timeline of recovery, ability to perform specific activities after surgery, and short-term and long-term restrictions following rTSA. (10.1016/j.xrrt.2024.09.005)
  • [L2] We developed two prognostic models containing partially different predictors, with acceptable performance for predicting (non-)recovery in patients with acute LBP, which was better than current practice. (10.1186/s12891-022-05718-7)
  • [L1] Open repair produces superior results compared with conservative treatment, with significantly lower recurrence rates and better long-term outcomes. (10.1016/j.arthro.2006.11.004)
  • [L4] Athletes conservatively managed returned 40% faster than those with surgery, though this appears to be associated with the severity and complexity of fractures treated surgically. (10.1016/j.jse.2021.04.006)
  • [L1] After arthroscopic supraspinatus tendon repair, image-guided PRP treatment on 2 occasions does not improve early tendon-bone healing or functional recovery. (10.1177/0363546515572602)
  • [L2] Increased knee flexion seemed to be a compensatory strategy for decreased ankle plantarflexion. (10.1177/03635465221129284)
  • [L3] Rehabilitation under ultrasonography monitoring may be a promising strategy to optimize early functional recovery after AATR repair for young people with high demands for sports. (10.1186/s13018-025-06282-1)
  • [L4] The two most consistent return to sport criteria reported in the literature are return of elbow range of motion and healing demonstrated on postoperative imaging. (10.1016/j.jseint.2023.11.003)
  • [L4] We recommend this treatment option for patients not demonstrating clinical improvement after 6 to 9 months of incomplete recovery. (10.1016/j.jhsa.2021.02.029)
  • [L3] Furthermore, our findings highlight a noticeable tendency toward the overcorrection of the deformity, as evidenced by increased pressure exerted on the lateral midfoot. (10.2106/jbjs.24.00394)
  • [L4] RLOR did not correlate with return to preinjury activity level, suggesting return to activity may be a more clinically relevant outcome measure than radiographic maintenance of reduction. (10.1016/j.arthro.2020.11.045)
  • [L4] Early return to play in athletes prior to full radiological union is not advised in case of refracture. (10.1007/s00167-012-2138-8)
  • [L5] Successful management of rotator cuff disease is dependent on appropriate rehabilitation, which should be based on an evaluation of underlying tissue quality and structural integrity rather than solely on empirical clinical experience or fixed healing timelines. (10.5435/00124635-200610000-00002)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L4] These immediate improvements in pain and function continue to improve at 6, 12, and 24 weeks postoperatively. (10.1016/j.jse.2015.12.025)
  • [L2] Females appear to perceive more limitations than males, while smokers unexpectedly experience less limitations in foot and ankle function. (10.1007/s00167-019-05586-0)
  • [L3] The resection did not restore normal function, as evidenced by gait analysis abnormalities. (10.2106/00004623-199703000-00008)
  • [L3] Compared with controls, both nonoperatively and surgically treated clubfeet had significant limitations in ankle plantar flexion resulting in decreased range of motion, moment, and power. (10.2106/jbjs.18.00317)
  • [L5] Rigid flatfoot deformities in adolescents have a less predictable clinical course and are associated with various underlying causes, making it critical to investigate the etiology to recommend proper management. (10.5435/jaaos-d-21-00448)
  • [L5] Surgical treatment involving deformity correction to recreate a plantigrade foot along with tendon transfers has been used with notable success to restore a near-normal gait, though limitations and postoperative dorsiflexion weakness have prompted investigation in nerve transfer as a possible alternative surgical treatment. (10.5435/jaaos-d-21-00717)

See Also

References

[1] Post-operative rehabilitation following traumatic anterior shoulder dislocation: A systematic scoping review. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221089636

[2] Rehabilitation Following Arthroscopic Rotator Cuff Repair: A Review of Current Literature. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-01-1

[3] Home‐Based or Supervised Physical Therapy Shows Similar Functional Outcomes and Healing After Massive Rotator Cuff Repair. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.06.037

[4] Study on proximal humerus evaluation of effective treatment (SPHEER) – what is the effect of rehabilitation compliance on clinical outcomes of proximal humerus fractures. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06894-w

[5] Hand Therapy Regimen for Functional Recovery Following Combined Face and Bilateral Hand Transplantation. HAND. 2022. DOI: 10.1177/15589447221124250

[6] Speed of recovery after arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.11.002

[7] Original Algorithm of Rehabilitation Protocol with Use of Ultrasound - Study Based on Achilles Tendon Reconstruction Cases. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00167

[8] Physical therapy versus natural history in outcomes of rotator cuff tears: the Rotator Cuff Outcomes Workgroup (ROW) cohort study. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.10.001

[9] Changes in Discharge to Rehabilitation: Potential Unintended Consequences of Medicare Total Hip Arthroplasty/Total Knee Arthroplasty Bundled Payments, Should They Be Implemented on a Nationwide Scale?. The Journal of Arthroplasty. 2019. DOI: 10.1016/j.arth.2019.01.068

[10] Rehabilitation after cervical and lumbar spine surgery. EFORT Open Reviews. 2023. DOI: 10.1530/eor-23-0015

[11] Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119884071

[12] Advances in the Rehabilitation of the Spinal Cord–Injured Patient: The Orthopaedic Surgeons' Perspective. Journal of the American Academy of Orthopaedic Surgeons. 2019. DOI: 10.5435/jaaos-d-18-00559

[13] A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.019

[14] A Randomized Trial Comparing Accelerated and Traditional Approaches to Postoperative Weightbearing Rehabilitation After Matrix-Induced Autologous Chondrocyte Implantation. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512445167

[15] Therapeutic efficacy of home-based neuromuscular electrical stimulation on early postoperative functional recovery following arthroscopic rotator cuff repair: a double-blind randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09030-y

[16] Accelerated rehabilitation after arthroscopic Bankart repair in professional footballers. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216647898

[17] Chapter 26 Hip Rehabilitation. 2019.

[18] Promoting work ability in a structured national rehabilitation program in patients with musculoskeletal disorders: outcomes and predictors in a prospective cohort study. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-57

[19] Psychological predictors of recovery from low back pain: a prospective study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0509-2

[20] Rehabilitation following Reverse Total Shoulder Replacement. Shoulder & Elbow. 2011. DOI: 10.1111/j.1758-5740.2011.00138.x

[21] Rehabilitation progress following reverse total shoulder replacement and internal fixation for geriatric three and four-part proximal humerus fractures – a propensity score matched comparison. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06669-3

[22] The Role of Therapeutic Modalities in Surgical and Nonsurgical Management of Orthopaedic Injuries. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-15-00348

[23] Stroke survivors talk while doing: Development of a therapeutic framework for continued rehabilitation of hand function post stroke. Journal of Hand Therapy. 2013. DOI: 10.1016/j.jht.2012.08.002

[24] Outcomes of the Ponseti Method for Untreated Clubfeet in Nepalese Patients Seen Between the Ages of One and Five Years and Followed for at Least 10 Years. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00445

[25] Orthopaedic Management of the Upper Extremity of Stroke Patients. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200808000-00005

[26] Functional outcomes are restored a decade after a distal radius fracture: a prospective long-term follow-up study. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231194682

[27] Evolution of Orthopaedic Rehabilitation Care. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-08-s80

[28] 12. Rehabilitation. 2013.

[29] Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.12.153

[30] Patient-reported outcomes following a physiotherapy rehabilitation programme for atraumatic posterior shoulder subluxation. Shoulder & Elbow. 2014. DOI: 10.1177/1758573213517218

[31] Predicting response to physiotherapy treatment for musculoskeletal shoulder pain: a systematic review. BMC Musculoskeletal Disorders. 2013. DOI: 10.1186/1471-2474-14-203

[32] Rehabilitation of the painful shoulder. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.07.013

[33] Shoulder and Elbow Recovery at 2 and 11 Years Following Brachial Plexus Reconstruction. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.11.010

[34] Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold. BioMed Research International. 2017. DOI: 10.1155/2017/6525373

[35] Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-200

[36] Effect of Acute Inpatient Rehabilitation on Outcome after Fracture of the Femoral Neck or Intertrochanteric Fracture. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199803000-00008

[37] A Five-Year Longitudinal Assessment of Quality of Life and Employment Status in Patients Who Have Osteonecrosis of the Femoral Head Undergoing Femoral Osteotomy: A Multicenter Study. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.06.066

[39] Long-term (seven-year) follow-up of sensory-motor rehabilitation therapy for task-specific focal hand dystonia. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.008

[40] Applying principles of motor learning and control to upper extremity rehabilitation. Journal of Hand Therapy. 2013. DOI: 10.1016/j.jht.2012.12.007

[41] A comparative effectiveness trial of postoperative management for lumbar spine surgery: changing behavior through physical therapy (CBPT) study protocol. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-325

[42] Serious games therapy associated with conventional physical therapy intervention accelerated hand muscles strengthening and hand functioning after complex fracture of the wrist: A case report. Journal of Hand Therapy. 2020. DOI: 10.1016/j.jht.2018.11.003

[43] A comprehensive five‐phase rehabilitation programme after hip arthroscopy for femoroacetabular impingement. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2664-z

[44] Early versus delayed mobilisation for non-surgically treated proximal humerus fractures: a systematic review and meta-analysis of randomised trials. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08371-y

[45] Hamstring muscle strength recovery remains incomplete at 2 years after harvest for ACL reconstruction and does not correlate with radiological tendon regeneration at 6 months: A prospective study. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70346

[46] Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta‐analysis of Randomized Controlled Trials. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.09.041

[47] The formal EU‐US Meniscus Rehabilitation 2024 Consensus: An ESSKA‐AOSSM‐AASPT initiative. Part II—Prevention, non‐operative treatment and return to sport. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.12689

[48] Online patients questions regarding reverse total shoulder arthroplasty pertain to timeline of recovery, specific activities, and limitations. JSES Reviews, Reports, and Techniques. 2025. DOI: 10.1016/j.xrrt.2024.09.005

[49] Development and internal validation of a machine learning prediction model for low back pain non-recovery in patients with an acute episode consulting a physiotherapist in primary care. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05718-7

[50] Primary Repair Versus Conservative Treatment of First‐Time Traumatic Anterior Dislocation of the Shoulder: A Randomized Study With 10‐Year Follow‐up. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.004

[51] Factors influencing time to return to sport following clavicular fractures in adolescent athletes. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.04.006

[52] Do Postoperative Platelet-Rich Plasma Injections Accelerate Early Tendon Healing and Functional Recovery After Arthroscopic Supraspinatus Repair?. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515572602

[54] Comparable Recovery and Compensatory Strategies in Heel-Rise Performance After a Surgically Repaired Acute Achilles Tendon Rupture: An In Vivo Kinematic Analysis Comparing Early Functional Mobilization and Standard Treatment. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221129284

[55] The short-term clinical effects of accelerated rehabilitation following open surgery for acute Achilles tendon rupture based on ultrasonography monitoring: a retrospective cohort study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06282-1

[56] Rehabilitation and return to sport criteria following surgical treatment of osteochondritis dissecans of the capitellum: a systematic review. JSES International. 2024. DOI: 10.1016/j.jseint.2023.11.003

[57] Nerve Transfers for Restoration of Elbow Flexion in Patients With Acute Flaccid Myelitis. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.02.029

[60] Outcomes of Calcaneal Lengthening Osteotomy in Ambulatory Patients with Cerebral Palsy and Planovalgus Foot Deformity. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.00394

[62] Arthroscopic‐Assisted Coracoclavicular Ligament Reconstruction: Clinical Outcomes and Return to Activity at Mean 6‐Year Follow‐Up. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.11.045

[63] Treatment and return to sport following a Jones fracture of the fifth metatarsal: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2138-8

[64] Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200610000-00002

[65] Hallux valgus deformity and postural sway: a cross-sectional study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04385-4

[66] Short-term outcomes after arthroscopic capsular release for adhesive capsulitis. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.025

[67] Understanding limitations in sport 1 year after an Achilles tendon rupture: a multicentre analysis of 285 patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05586-0

[68] Gait Abnormalities following Resection of Talocalcaneal Coalition. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199703000-00008

[69] Functional Outcomes Following Treatment for Clubfoot. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00317

[73] Evaluation and Management of Adolescents With a Stiff Flatfoot. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-00448

[75] Evaluation and Management of Adult Footdrop. Journal of the American Academy of Orthopaedic Surgeons. 2022. DOI: 10.5435/jaaos-d-21-00717

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