Bryan M Saltzman1, William A Zuke1, Beatrice Go1, Randy Mascarenhas2, Nikhil N Verma1, Brian J Cole1, Anthony A Romeo1, Brian Forsythe3. 1. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. 2. Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA. 3. Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA. Electronic address: forsythe.research@rushortho.com.
Abstract
BACKGROUND: The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. METHODS: Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repair with early-motion vs. delayed-motion rehabilitation protocols. Clinical data were extracted, and meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses and Oxman-Guyatt scales. RESULTS: Nine meta-analyses met inclusion criteria. No clear superiority was noted in clinical outcome scores for early-motion or delayed-motion rehabilitation. Results of tendon healing were found to be either no different or in favor of delayed motion, but no differences were noted in rotator cuff tear recurrence rates postoperatively. The majority of meta-analyses found significantly better range of motion with early motion up to a year postoperatively for forward elevation and up to 6 months for external rotation, but significant differences were not reported for functional improvements and strength at 12 months postoperatively. Subgroup analyses suggested that larger preoperative tear sizes have significantly greater retear rates with early-motion rehabilitation. CONCLUSIONS: The current highest level of evidence suggests that early-motion rehabilitation after rotator cuff repair results in superior postoperative range of motion up to 1 year. Whereas early motion and delayed motion after cuff repair may lead to comparable functional outcomes and retear rates, concern exists that early motion may result in greater retear rates, particularly with larger tear sizes.
BACKGROUND: The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. METHODS: Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repair with early-motion vs. delayed-motion rehabilitation protocols. Clinical data were extracted, and meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses and Oxman-Guyatt scales. RESULTS: Nine meta-analyses met inclusion criteria. No clear superiority was noted in clinical outcome scores for early-motion or delayed-motion rehabilitation. Results of tendon healing were found to be either no different or in favor of delayed motion, but no differences were noted in rotator cuff tear recurrence rates postoperatively. The majority of meta-analyses found significantly better range of motion with early motion up to a year postoperatively for forward elevation and up to 6 months for external rotation, but significant differences were not reported for functional improvements and strength at 12 months postoperatively. Subgroup analyses suggested that larger preoperative tear sizes have significantly greater retear rates with early-motion rehabilitation. CONCLUSIONS: The current highest level of evidence suggests that early-motion rehabilitation after rotator cuff repair results in superior postoperative range of motion up to 1 year. Whereas early motion and delayed motion after cuff repair may lead to comparable functional outcomes and retear rates, concern exists that early motion may result in greater retear rates, particularly with larger tear sizes.
Authors: Luane Landim de Almeida; Adriano Fernando Mendes Júnior; José da Mota Neto; Leandro Furtado De Simoni; Karine Helena Souza Lopes; Paloma Carvalho Guimarães; Brenda Iasmin de Oliveira Valério; Aaron Sciascia Journal: Int J Sports Phys Ther Date: 2021-02-01
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