Riboh, Arthroscopy 2014 - Early Passive Motion versus Immobilization after Arthroscopic Rotator Cuff Repair

Early Passive Motion versus Immobilization after Arthroscopic Rotator Cuff Repair

Riboh, Garrigues·Arthroscopy·2014·58 citations

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. Copyright remains with the authors and publisher.

Supplemental

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Early Passive Motion versus Immobilization after Arthroscopic Rotator Cuff Repair

Riboh, Garrigues·Arthroscopy·2014·58 citations

DOI·PubMed

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

Level of evidence: Level II, meta-analysis of Level II studies and qualitative review of Level IV study. Copyright remains with the authors and publisher.

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

Level of evidence: Level II, meta-analysis of Level II studies and qualitative review of Level IV study. Copyright remains with the authors and publisher.

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

Level of evidence: Level II, meta-analysis of Level II studies and qualitative review of Level IV study. Copyright remains with the authors and publisher.