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Meta-Analysis
. 2021 Dec;91(12):2773-2779.
doi: 10.1111/ans.17213. Epub 2021 Sep 28.

Rehabilitation protocols following rotator cuff repair: a meta-analysis of current evidence

Udara Bandara  1 , Vincent V G An  2 , Sahand Imani  1 , Haren Nandapalan  3 , Brahman S Sivakumar  1
Affiliations
Meta-Analysis

Rehabilitation protocols following rotator cuff repair: a meta-analysis of current evidence

Udara Bandara et al. ANZ J Surg. 2021 Dec.

Abstract

Background: Rotator cuff tears are a common shoulder pathology with an increasing incidence. The optimum post-operative rehab protocol remains unclear and can consist of either conservative rehabilitation or more aggressive early range-of-motion. Multiple studies have assessed these treatment protocols. This meta-analysis aims to compare post-operative clinical outcomes following either conservative or aggressive rehabilitation post rotator cuff repair.

Methods: A systematic electronic literature search was undertaken using a number of databases. Eligible studies included randomized control trials published between January 2013 and April 2019 in English with patients having had received rotator cuff repair. Post-operative clinical outcomes considered included shoulder range-of-motion, overall function status (Costant-Murley score) and rates of rotator-cuff re-tear. Studies were evaluated for methodological quality in accordance with the Physiotherapy Evidence Database (PEDro) scale. Summarized pooled statistics were calculated using Review Manager (v5.3) software.

Results: A total of six randomized controlled trials were included. Standardized mean difference (SMD) in shoulder flexion, abduction and external rotation was not statistically significant at either 6 or 12 months post rotator cuff repair. Functional assessment suggests a slight benefit in Constant-Murley Score (SMD = 1.77; 95% CI -3.93, 7.47) in aggressive treatment groups with no significant risk increase for cuff re-tear (RR = 1.22; 95% CI 0.60, 2.47).

Conclusion: This meta-analysis suggests there is no clear benefit of either rehabilitation protocol when considering range-of-motion, with a possible benefit in functional outcome at the cost of increased re-tear risk post aggressive rehabilitation. Both protocols have been shown to offer safe reproducible short- and long-term outcomes.

Keywords: aggressive physiotherapy; arthroscopic reconstruction; delayed physiotherapy; meta-analysis; rotator cuff.

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