Does Early Versus Delayed Active Range of Motion Affect Rotator Cuff Healing After Surgical Repair? A Systematic Review and Meta-analysis.
BACKGROUND
The timing of passive range of motion (ROM) after surgical repair of the rotator cuff (RC) has been shown to affect healing. However, it is unknown if early or delayed active ROM affects healing.


OBJECTIVE
To determine whether early versus delayed active ROM affects structural results of RC repair surgery.


METHODS
Systematic review and meta-analysis.


METHODS
A systematic review of articles published between January 2004 and April 2014 was conducted. Structural results were compared for early (<6 weeks after surgery) versus delayed (≥6 weeks after surgery) active ROM using chi-square and Fisher exact tests, as well as relative risks (RRs) and 95% CIs. The analyses were stratified by tear size and repair method.


RESULTS
A total of 37 studies (2251 repairs) were included in the analysis, with 10 (649 repairs) in the early group and 27 (1602 repairs) in the delayed group. For tears ≤3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for transosseous plus single-row suture anchor repairs (39.7% vs 24.3%; RR, 1.63 [95% CI, 1.28-2.08]). For tears >3 cm, the risk of a structural tendon defect was higher in the early versus delayed group for suture bridge repairs (48% vs 17.5%; RR, 2.74 [95% CI, 1.59-4.73]) and all repair methods combined (40.5% vs 26.7%; RR, 1.52 [95% CI, 1.17-1.97]). For tears >5 cm, the risk of structural tendon defect was higher in the early versus delayed group for suture bridge repairs (100% vs 16.7%; RR, 6.00 [95% CI, 1.69-21.26]). There were no statistically significant associations for tears measuring ≤1, 1-3, or 3-5 cm.


CONCLUSIONS
Early active ROM was associated with increased risk of a structural defect for small and large RC tears, and thus might not be advisable after RC repair.
University at Buffalo, The State University of New York, Buffalo, New York, USA.
Melissa A
MA
Kluczynski
University at Buffalo, The State University of New York, Buffalo, New York, USA.
Maureen M
MM
Isenburg
University at Buffalo, The State University of New York, Buffalo, New York, USA.
John M
JM
Marzo
University at Buffalo, The State University of New York, Buffalo, New York, USA ljbisson@buffalo.edu.
Leslie J
LJ
Bisson
D001178:Arthroplasty; D001182:Arthroscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular / Q000502:physiology*; D012046:Rehabilitation / Q000379:methods; D017006:Rotator Cuff / Q000503:physiopathology*; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000601:surgery; D053441:Suture Anchors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*
active range of motion; healing; rehabilitation; rotator cuff