title: Early Versus Delayed Passive Range of Motion Exercise for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials.
abstract: BACKGROUND
  Postoperative shoulder stiffness complicates functional recovery after arthroscopic rotator cuff repair.
  
  
  OBJECTIVE
  To compare early passive range of motion (ROM) exercise with a delayed rehabilitation protocol with regard to the effectiveness of stiffness reduction and functional improvements and rates of improper healing in patients undergoing arthroscopic repair for torn rotator cuffs.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Randomized controlled trials (RCTs) comparing both rehabilitation approaches were identified in PubMed and Scopus. Between-group differences in shoulder function were transformed to effect sizes for comparisons, whereas the effectiveness against stiffness and the risk of tendon failure were reported using standardized mean differences of ROM degrees and odds ratios (ORs) of recurrent tears, respectively.
  
  
  RESULTS
  Six RCTs were included, consisting of 482 patients. No significant difference in shoulder function existed across both protocols. The early ROM group demonstrated more improvement in shoulder forward flexion than the delayed rehabilitation group, with a standardized mean difference of 7.45° (95% CI, 3.20°-11.70°) at 6 months and 3.51° (95% CI, 0.31°-6.71°) at 12 months. Early ROM exercise tended to cause a higher rate of recurrent tendon tears (OR, 1.43; 95% CI, 0.90-2.28), and the effect became statistically significant (OR, 1.93; 95% CI, 1.04-3.60) after excluding 2 RCTs that recruited only those patients with small to medium-sized tears.
  
  
  CONCLUSIONS
  Early ROM exercise accelerated recovery from postoperative stiffness for patients after arthroscopic rotator cuff repair but was likely to result in improper tendon healing in shoulders with large-sized tears. The choice of either protocol should be based on an accommodation of the risks of recurrent tears and postoperative shoulder stiffness.
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital-Bei-Hu Branch, National Taiwan University College of Medicine, Taipei, Taiwan Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Ke-Vin
authors.initials: KV
authors.lastname: Chang
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Chen-Yu
authors.initials: CY
authors.lastname: Hung
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital-Bei-Hu Branch, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Der-Sheng
authors.initials: DS
authors.lastname: Han
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Wen-Shiang
authors.initials: WS
authors.lastname: Chen
authors.affiliation: Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Tyng-Guey
authors.initials: TG
authors.lastname: Wang
authors.affiliation: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan klchien@ntu.edu.tw.
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D020127:Recovery of Function; D017006:Rotator Cuff / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing
keywords: arthroscopic surgery; range of motion exercise; rehabilitation; rotator cuff; shoulder