Does immobilization after arthroscopic rotator cuff repair increase tendon healing? A systematic review and meta-analysis

• Published in: Archives of orthopaedic and trauma surgery Vol. 134; no. 9; pp. 1279 - 1285
• Main Authors: Shen, Chong, Tang, Zhi-Hong, Hu, Jun-Zu, Zou, Guo-Yao, Xiao, Rong-Chi, Yan, Dong-Xue
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2014; Springer Nature B.V
• Subjects: Arthroscopy - rehabilitation; Arthroscopy and Sports Medicine; Exercise Therapy - methods; Humans; Immobilization; Medicine; Medicine & Public Health; Meta-analysis; Models, Statistical; Orthopedics; Pain Measurement; Postoperative Care - methods; Range of Motion, Articular; Rotator cuff; Rotator Cuff - surgery; Rotator Cuff Injuries; Shoulder Joint - injuries; Shoulder Joint - physiology; Shoulder Joint - surgery; Systematic review; Tendon Injuries - rehabilitation; Tendon Injuries - surgery; Treatment Outcome; Wound Healing; Arthroscopic rotator cuff repair; Tendon healing; Rehabilitation; Meta-analysis
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s00402-014-2028-2

Introduction To determine whether immobilization after arthroscopic rotator cuff repair improved tendon healing compared with early passive motion. Materials and methods A systematic electronic literature search was conducted to identify randomized controlled trials (RCTs) comparing early passive motion with immobilization after arthroscopic rotator cuff repair. The primary outcome assessed was tendon healing in the repaired cuff. Secondary outcome measures were range of motion (ROM) and American Shoulder and Elbow Surgeons (ASES) shoulder scale, Simple Shoulder Test (SST), Constant, and visual analog scale (VAS) for pain scores. Pooled analyses were performed using a random effects model to obtain summary estimates of treatment effect with 95 % confidence intervals. Heterogeneity among included studies was quantified. Results Three RCTs examining 265 patients were included. Meta-analysis revealed no significant difference in tendon healing in the repaired cuff between the early-motion and immobilization groups. A significant difference in external rotation at 6 months postoperatively favored early motion over immobilization, but no significant difference was observed at 1 year postoperatively. In one study, Constant scores were slightly higher in the early-motion group than in the immobilization group. Two studies found no significant difference in ASES, SST, or VAS score between groups. Conclusion We found no evidence that immobilization after arthroscopic rotator cuff repair was superior to early-motion rehabilitation in terms of tendon healing or clinical outcome. Patients in the early-motion group may recover ROM more rapidly. Level of evidence Level II; systematic review of levels I and II studies.