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Early Passive Motion Versus Immobilization After Arthroscopic Rotator Cuff Repair

      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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      Linked Article

      • Error in the Article “Early Passive Motion Versus Immobilization After Arthroscopic Rotator Cuff Repair”
        ArthroscopyVol. 30Issue 10
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          Recently, 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.
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