Purpose
To provide a synthesis of the highest-quality literature available comparing early
passive motion (EPM) with strict sling immobilization during the first 4 to 6 weeks
after surgery.
Methods
The Medline, Cochrane, and Embase databases were searched for eligible studies. We
reviewed 886 citations, and 5 randomized clinical trials (RCTs) (Level II) met the
inclusion criteria for meta-analysis. Four RCTs contributed to the analysis of range
of motion, and 5 contributed to the analysis of retear rates. A single Level IV study
was available for qualitative review. Random-effects models were used for meta-analysis,
computing mean differences for continuous variables and risk ratios for dichotomous
variables.
Results
EPM resulted in improved shoulder forward flexion at 3 months (mean difference, 14.70°;
95% confidence interval [CI], 5.52° to 23.87°; P = .002), 6 months (mean difference, 4.31°; 95% CI, 0.17° to 8.45°; P = .04), and 12 months (mean difference, 4.18°; 95% CI, 0.36° to 8.00°; P = .03). External rotation at the side was only superior with EPM at 3 months (mean
difference, 10.43°; 95% CI, 4.51° to 16.34°; P = .0006). Rotator cuff retear rates (16.3% for immobilization v 21.1% for EPM; risk ratio, 0.82; 95% CI, 0.57 to 1.20; P = .31) were not significantly different between EPM and immobilization at a minimum
of 1 year of follow-up.
Conclusions
A small number of RCTs with low to moderate risks of bias are currently available.
Meta-analysis suggests that after primary arthroscopic rotator cuff repair of small
to medium tears, EPM results in 15° of improved forward flexion at 3 months and approximately
5° at 6 and 12 months. External rotation is improved by 10° with EPM at 3 months only.
The clinical importance of these differences has yet to be determined. Retear rates
at a minimum of 1 year of follow-up are not clearly affected by type of rehabilitation.
Level of Evidence
Level II, meta-analysis of Level II studies and qualitative review of Level IV study.
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Article Info
Publication History
Published online: May 09, 2014
Accepted:
March 11,
2014
Received:
September 21,
2013
Footnotes
The authors report the following potential conflict of interest or source of funding: G.E.G. receives support from Tornier , AO/Synthes , Consultant, Medicolegal, Expert witness, document review, Zimmer, DJO. Educational grants for residency/fellowship education, Tornier, Training courses.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Error in the Article “Early Passive Motion Versus Immobilization After Arthroscopic Rotator Cuff Repair”ArthroscopyVol. 30Issue 10
- PreviewRecently, the article “Early passive motion versus immobilization after arthroscopic rotator cuff repair” by Riboh and Garrigues1 was published in Arthroscopy. However, there is a mistake in the data. In the analysis of range of motion 3, 6, and 12 months after surgery, the authors stated that the patient number in the study by Keener et al.2 was 61 in the early motion group versus 53 in the immobilization group. However, in their article, Keener et al. stated, “Outcomes data were available for 103 (83%) of 124 subjects at six months, 105 (85%) of 124 subjects at twelve months, and 103 (83%) of 124 subjects at twenty-four months.” As a result, I am wondering whether there are any errors in the data of Riboh and Garrigues.
- Full-Text
- Preview
