Background: 

Evidence-based guidelines are lacking for return to driving following rotator cuff repair (RCR). As a result, surgeons are often overly conservative in their recommendations, placing potential undue burden on patients and their families. Therefore, the primary objective of this study was to formulate evidence-based return-to-driving guidelines.

Methods: 

Thirty-two subjects planning to undergo primary RCR were enrolled. Driving fitness was assessed in a naturalistic setting with an instrumented vehicle on public streets with a safety monitor onboard. Driving kinematic measures and behavioral data were obtained from vehicle data and camera capture. Several driving tasks and maneuvers were evaluated, including parking, left and right turns, straightaways, yielding, highway merges, and U-turns. The total course length was 15 miles (24 km) and the course took 45 to 55 minutes to complete. The subjects’ baseline drive was performed prior to RCR and postoperative drives occurred at 2, 4, 6, and 12 weeks after RCR. All drives consisted of identical routes, tasks, and maneuvers. Driving metrics were analyzed for differences between baseline and postoperative drives, including differences in gravitational force equivalents (g).

Results: 

Twenty-seven subjects (mean age, 58.6 years [range, 43 to 68 years]) completed all 5 drives. Of the 13 analyzed kinematic metrics measured from 14 of 17 driving events, all exhibited noninferiority across all postoperative drives (2 to 12 weeks) after RCR compared with baseline. Beginning at postoperative week 2, subjects generally braked less aggressively, steered more smoothly, and drove more stably. Kinematic metrics during the performance of specific maneuver types also showed noninferiority when compared with baseline. Of note, subjects drove more smoothly on highway merges starting at postoperative week 2 (minimum longitudinal acceleration, −0.35 g [95% confidence interval (CI), −0.050 to −0.019 g]; standard deviation of longitudinal acceleration, 0.008 g [95% CI, 0.003 to 0.013 g]), but exhibited more aggressive driving and acceleration on highway merges at postoperative week 12 (maximum absolute yaw, −0.8°/sec [95% CI, −1.2°/sec to −0.4°/sec]).

Conclusions: 

Patients showed no clinically important negative impact on driving fitness as early as 2 weeks after RCR. Adaptive behaviors were present both preoperatively and postoperatively.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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接受肩袖修复的患者可以在术后 2 周安全恢复驾驶

背景： 

肩袖修复 (RCR) 后缺乏恢复驾驶的循证指南。因此，外科医生的建议往往过于保守，给患者及其家人带来潜在的不当负担。因此，本研究的主要目的是制定基于证据的重返驾驶指南。

方法： 

计划进行初级 RCR 的 32 名受试者被纳入。驾驶健康状况是在公共街道上使用装有安全监视器的仪表车辆在自然环境中进行评估的。驾驶运动学测量和行为数据是从车辆数据和摄像机捕获中获得的。评估了多种驾驶任务和操作，包括停车、左转和右转、直行、让路、高速公路并道和掉头。路线总长度为 15 英里（24 公里），完成路线需要 45 至 55 分钟。受试者的基线驱动在 RCR 之前进行，术后驱动在 RCR 后 2、4、6 和 12 周进行。所有驾驶都包含相同的路线、任务和操作。分析了驱动指标的基线和术后驱动之间的差异，包括重力当量（g）的差异。

结果： 

27 名受试者（平均年龄，58.6 岁[范围，43 至 68 岁]）完成了全部 5 次驾驶。在 17 个驾驶事件中的 14 个中测量的 13 个分析运动学指标中，与基线相比，在 RCR 后的所有术后驾驶（2 至 12 周）中，所有指标均表现出非劣效性。从术后第 2 周开始，受试者普遍制动不那么剧烈，转向更加平稳，驾驶也更加稳定。与基线相比，执行特定机动类型期间的运动学指标也显示出非劣性。值得注意的是，受试者从术后第 2 周开始在高速公路并道上行驶更加平稳（最小纵向加速度，-0.35 g [95% 置信区间 (CI)，-0.050 至 -0.019 g]；纵向加速度的标准偏差，0.008 g [95 % CI，0.003 至 0.013 g]），但术后第 12 周在高速公路汇合处表现出更激进的驾驶和加速（最大绝对偏航，-0.8°/秒 [95% CI，-1.2°/秒至 -0.4°/秒） ]）。

结论： 

早在 RCR 后 2 周，患者就没有表现出对驾驶健康产生临床上重要的负面影响。术前和术后均存在适应性行为。

证据级别： 

预后II 级。有关证据级别的完整描述，请参阅作者须知。