Kevin Chan1, Joy C MacDermid2, Daniel J Hoppe1, Olufemi R Ayeni1, Mohit Bhandari1, Clary J Foote1, George S Athwal3. 1. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. 2. The Hand and Upper Limb Centre, Division of Orthopaedic Surgery, Department of Surgery, Western University, London, ON, Canada. 3. The Hand and Upper Limb Centre, Division of Orthopaedic Surgery, Department of Surgery, Western University, London, ON, Canada. Electronic address: gathwal@uwo.ca.
Abstract
BACKGROUND: We conducted a meta-analysis of randomized trials to compare delayed vs early motion therapy on function after arthroscopic rotator cuff repair. METHODS: We searched 4 electronic databases (Medline, Embase, Cochrane, and Physiotherapy Evidence Database [PEDro]). The methodologic quality of the included studies was assessed, and the relevant data were extracted. Data were pooled for functional outcomes, rotator cuff tear recurrence, and shoulder range of motion. Complications were reported descriptively. RESULTS: Three level I and 1 level II randomized trials were eligible and included. Pooled analysis revealed no statistically significant differences in American Shoulder and Elbow Surgeons scores between delayed vs early motion rehabilitation (mean difference [MD], 1.4; 95% confidence interval [CI], -1.8 to 4.7; P = .38, I(2) = 34%). The risk of retears after surgery did not differ statistically between treatment groups (risk ratio, 1.01; 95% CI, 0.63-1.64; P = .95). Early passive motion led to a statistically significant, although clinically unimportant, improvement in forward elevation between groups (MD, -1°; 95% CI, -2° to 0°; P = 0.04, I(2) = 0%). There was no difference in external rotation between treatment groups (MD, 1°; 95% CI, -2° to 4°; P = 0.63, I(2) = 0%). None of the included studies identified any cases of postoperative shoulder stiffness. CONCLUSIONS: The current meta-analysis did not identify any significant differences in functional outcomes and relative risks of recurrent tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A statistically significant difference in forward elevation range of motion was identified; however, this difference is likely clinically unimportant.
BACKGROUND: We conducted a meta-analysis of randomized trials to compare delayed vs early motion therapy on function after arthroscopic rotator cuff repair. METHODS: We searched 4 electronic databases (Medline, Embase, Cochrane, and Physiotherapy Evidence Database [PEDro]). The methodologic quality of the included studies was assessed, and the relevant data were extracted. Data were pooled for functional outcomes, rotator cuff tear recurrence, and shoulder range of motion. Complications were reported descriptively. RESULTS: Three level I and 1 level II randomized trials were eligible and included. Pooled analysis revealed no statistically significant differences in American Shoulder and Elbow Surgeons scores between delayed vs early motion rehabilitation (mean difference [MD], 1.4; 95% confidence interval [CI], -1.8 to 4.7; P = .38, I(2) = 34%). The risk of retears after surgery did not differ statistically between treatment groups (risk ratio, 1.01; 95% CI, 0.63-1.64; P = .95). Early passive motion led to a statistically significant, although clinically unimportant, improvement in forward elevation between groups (MD, -1°; 95% CI, -2° to 0°; P = 0.04, I(2) = 0%). There was no difference in external rotation between treatment groups (MD, 1°; 95% CI, -2° to 4°; P = 0.63, I(2) = 0%). None of the included studies identified any cases of postoperative shoulder stiffness. CONCLUSIONS: The current meta-analysis did not identify any significant differences in functional outcomes and relative risks of recurrent tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A statistically significant difference in forward elevation range of motion was identified; however, this difference is likely clinically unimportant.
Authors: Christian Jung; Lena Tepohl; Reina Tholen; Knut Beitzel; Stefan Buchmann; Thomas Gottfried; Casper Grim; Bettina Mauch; Gert Krischak; Hans Ortmann; Christian Schoch; Frieder Mauch Journal: Obere Extrem Date: 2018-02-22
Authors: Birgitte Hougs Kjær; S Peter Magnusson; Susan Warming; Marius Henriksen; Michael Rindom Krogsgaard; Birgit Juul-Kristensen Journal: Trials Date: 2018-09-03 Impact factor: 2.279