Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis

Background We conducted a meta-analysis of randomized trials to compare delayed vs early motion therapy on function after arthroscopic rotator cuff repair. Methods We searched 4 electronic databases (Medline, Embase, Cochrane, and Physiotherapy Evidence Database [PEDro]). The methodologic quality of the included studies was assessed, and the relevant data were extracted. Data were pooled for functional outcomes, rotator cuff tear recurrence, and shoulder range of motion. Complications were reported descriptively. Results Three level I and 1 level II randomized trials were eligible and included. Pooled analysis revealed no statistically significant differences in American Shoulder and Elbow Surgeons scores between delayed vs early motion rehabilitation (mean difference [MD], 1.4; 95% confidence interval [CI], −1.8 to 4.7; P  = .38, I 2  = 34%). The risk of retears after surgery did not differ statistically between treatment groups (risk ratio, 1.01; 95% CI, 0.63–1.64; P  = .95). Early passive motion led to a statistically significant, although clinically unimportant, improvement in forward elevation between groups (MD, −1°; 95% CI, −2° to 0°; P = 0.04, I 2 = 0%). There was no difference in external rotation between treatment groups (MD, 1°; 95% CI, −2° to 4°; P = 0.63, I 2 = 0%). None of the included studies identified any cases of postoperative shoulder stiffness. Conclusions The current meta-analysis did not identify any significant differences in functional outcomes and relative risks of recurrent tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A statistically significant difference in forward elevation range of motion was identified; however, this difference is likely clinically unimportant.