title: Early passive motion versus immobilization after arthroscopic rotator cuff repair.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Level II, meta-analysis of Level II studies and qualitative review of Level IV study.
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Riboh
authors.affiliation: Division of Sports Medicine and Shoulder Surgery, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, U.S.A.. Electronic address: Grant.garrigues@dm.duke.edu.
authors.forename: Grant E
authors.initials: GE
authors.lastname: Garrigues
mesh_terms: D001182:Arthroscopy / Q000534:rehabilitation*; D005081:Exercise Therapy; D006801:Humans; D007103:Immobilization; D016059:Range of Motion, Articular; D012399:Rotation; D017006:Rotator Cuff / Q000601:surgery*; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome