Rotator Cuff Surgery: Hide the Car Keys?

The summer 2015 issue of the Journal of Surgical Orthopedic Advances discusses a question that continues to vex surgeons and patients alike: when can patients who have arthroscopic rotator cuff repair drive again and what are the patient's perceptions? To date, no clear guideline has been developed for driving safety and maneuverability during post-operative recovery.

The summer 2015 issue of the Journal of Surgical Orthopedic Advances discusses a question that continues to vex surgeons and patients alike: when can patients who have arthroscopic rotator cuff repair drive again and what are the patient’s perceptions? To date, no clear guideline has been developed for driving safety and maneuverability during post-operative recovery. Some surgeons establish a waiting period, but pain, weakness, opioid use, and slings can affect driving abilities and will differ among patients.

Researchers at the University of Iowa Hospital in Iowa City designed a survey that looked at patients' return to driving after rotator cuff surgery—this study documents patient perspective. They queried patients about pain, weakness, sling use, and narcotics and looked for correlates to self-assessed safety and maneuvering.

They identified a prospective single surgeon cohort of 54 patients undergoing arthroscopic rotator cuff repair between February 1, 2009 and January 31, 2010. At 4 months after surgery, they asked participants to report when they returned to driving, when they felt safe driving, and how they viewed maneuverability. In addition, they asked about pain, drug use, weakness, and use of slings.

They found the time period patients waited before return to driving varied significantly. Some patients resumed driving the same day they were operated, while 2 patients were still not driving at 4 months. Patient perception of safety was similar regardless of when they returned to driving.

Among patients who returned to driving, 12% reported narcotics use and 33% reported sling use while driving. Neither narcotics use nor sling use had significant impact on patient perception of safety or driving maneuverability.

Pain was closely link to feeling unsafe driving, and patients reporting pain were 2.9 times more likely to feel unsafe and 3.7 times more likely to report maneuvering difficulty.

Weakness was also closely related to feeling unsafe behind the wheel. Participants who experienced weakness were 2.8 times more likely to feel unsafe driving and 2.5 times more likely to report maneuvering difficulty.

The researchers conclude that the patient's perception of safety at their return to driving time is unrelated to time from surgery and quite variable. Surgeons can use these findings to counsel patients on when to return to driving following arthroscopic rotator cuff repair rather than recommend preconceived wait times. Pain may be the best surrogate for safe driving.