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Meta-Analysis
. 2021 Jul 24;22(1):637.
doi: 10.1186/s12891-021-04397-0.

Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

Umile Giuseppe Longo  1 , Laura Risi Ambrogioni  2 , Alessandra Berton  2 , Vincenzo Candela  2 , Filippo Migliorini  2 , Arianna Carnevale  3 , Emiliano Schena  3 , Ara Nazarian  4 , Joseph DeAngelis  4 , Vincenzo Denaro  2
Affiliations
Meta-Analysis

Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis

Umile Giuseppe Longo et al. BMC Musculoskelet Disord. .

Abstract

Background: The purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.

Methods: According to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.

Results: The search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up.

Conclusions: No statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.

Keywords: Accelerated; Conservative; Protocol; Rehabilitation; Rotator cuff; Rotator cuff repair.

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Conflict of interest statement

U.G.L. is a member of the Editorial Board of B.M.C. Musculoskeletal Disorders. The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram representing individual study inclusion after applying the study algorithm
Fig. 2
Fig. 2
Risk of bias summary: review authors’ judgements about each risk of bias item for each included study
Fig. 3
Fig. 3
Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.
Fig. 4
Fig. 4
Forest plot of retear. No statistically significant differences were found in retear rate between patients who followed the accelerated rehabilitation protocol and those treated conservatively (P = 0.29; I2 = 0 %).
Fig. 5
Fig. 5
Forest plot of forward elevation at 3-month follow-up. No statistically significant differences were found in forward elevation between patients who followed the accelerated rehabilitation protocol and those treated conservatively (P = 0.1; I2 = 90 %)
Fig. 6
Fig. 6
Forest plot of external rotation at 3-month follow-up. The accelerated group provide better results in external rotation than conservative group (P < 0.05; I2 = 81 %)
Fig. 7
Fig. 7
Forest plot of abduction at 3-month follow-up. No statistically significant differences were found in abduction between patients who followed the accelerated rehabilitation protocol and those treated conservatively (P = 0.11; I2 = 79 %)
Fig. 8
Fig. 8
Forest plot of CMS at 6-month follow-up. No statistically significant differences were found in Constant-Murley score between patients who followed the accelerated rehabilitation protocol and those treated conservatively (P = 0.34; I2 = 95 %)
Fig. 9
Fig. 9
Forest plot of forward elevation at 6-month follow-up. The accelerated group provide better results in forward elevation than conservative group (P < 0.05; I2 = 12 %)
Fig. 10
Fig. 10
Forest plot of external rotation at 6-month follow-up. The accelerated group provide better results in external rotation than conservative group (P < 0.05; I2 = 58 %)
Fig. 11
Fig. 11
Forest plot of forward elevation at 12-month follow-up. The accelerated group provide better results in forward elevation than conservative group (P < 0.05; I2 = 92 %)
Fig. 12
Fig. 12
Funnel plots of comparisons: conservative versus accelerated rehabilitation protocols
See this image and copyright information in PMC

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