Rehabilitation protocol after arthroscopic rotator cuff repair: early versus delayed motion

Purpose: To evaluate the effectiveness of early and delayed motion in rehabilitation after arthroscopic rotator cuff repair using a meta-analysis from randomized controlled trials. Materials and Methods: Electronic searches of the CENTRAL, PUBMED, and EMBASE were used to identify randomized controlled trials that evaluated the effectiveness and safety of early and delayed motion for rehabilitation after arthroscopic rotator cuff repair. The methodological quality of the studies was assessed by the Cochrane Collaboration tool for assessing risk of bias. Results: Four randomized controlled trials involving a total of 348 shoulders were included. Of these, two were rated as high quality and two were rated as moderate quality. No significant publication bias was detected by Egger's test and sensitivity analysis demonstrates a statistically robust result. Our meta-analysis indicated that early motion after arthroscopic rotator cuff repair resulted in a significantly greater recovery of external rotation from pre-operation to 3, 6, and 12 months post-operation (P < 0.05) and forward elevation ability from pre-operation to 6 months post-operation (P < 0.05), as compared to when motion was delayed. However, early motion resulted in non-significant excess (P > 0.05) in the rate of recurrence, compared to delayed motion. In addition, there were statistically higher rating scale of the American Shoulder and Elbow Surgeons (ASES) scores at 12 months post-operation (P < 0.05) and healing rates (P < 0.05) with delayed motion after arthroscopic rotator cuff repair, compared with early motion. Conclusion: Our meta-analysis included data from randomized controlled trials and demonstrated that delayed motion after arthroscopic rotator cuff repair resulted in higher healing rates and ASES scores than early motion. Alternatively, early motion increased range of motion (ROM) recovery, but also increased the rate of recurrence compared to delayed motion.