title: Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses.
abstract: BACKGROUND
  Previous meta-analyses have been conducted to compare outcomes of early versus delayed motion after rotator cuff repair.
  
  
  OBJECTIVE
  To conduct a systematic review of overlapping meta-analyses comparing early versus delayed motion rehabilitation protocols after rotator cuff repair to determine which meta-analyses provide the best available evidence.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic review was performed by searching PubMed and Cochrane Library databases. Search terms included "rotator cuff repair," "early passive motion," "immobilization," "rehabilitation protocol," and "meta-analysis." Results were reviewed to determine study eligibility. Patient outcomes and structural healing were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence.
  
  
  RESULTS
  Seven meta-analyses containing a total of 5896 patients met the eligibility criteria (1 Level I evidence, 4 Level II evidence, 2 Level III evidence). None of these meta-analyses found immobilization to be superior to early motion; however, most studies suggested that early motion would increase range of motion (ROM), thereby reducing time of recovery. Three of these studies suggested that tear size contributed to the choice of rehabilitation to ensure proper healing of the shoulder. A study by Chan et al in 2014 received the highest QUOROM and Oxman-Guyatt scores, and therefore this meta-analysis appeared to have the highest level of evidence. Additionally, a study by Riboh and Garrigues in 2014 was selected as the highest quality study in this systematic review according to the Jadad decision algorithm.
  
  
  CONCLUSIONS
  The current, best available evidence suggests that early motion improves ROM after rotator cuff repair but increases the risk of rotator cuff retear. Lower quality meta-analyses indicate that tear size may provide a better strategy in determining the correct rehabilitation protocol.
authors.affiliation: University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
authors.forename: Darby A
authors.initials: DA
authors.lastname: Houck
authors.affiliation: University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kraeutler
authors.affiliation: University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Schuette
authors.affiliation: University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
authors.forename: Eric C
authors.initials: EC
authors.lastname: McCarty
authors.affiliation: University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Bravman
mesh_terms: D001182:Arthroscopy; D004434:Early Ambulation; D006801:Humans; D007103:Immobilization; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000502:physiology* / Q000601:surgery*; D000070636:Rotator Cuff Injuries / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
keywords: delayed motion; early motion; immobilization; meta-analysis; rehabilitation; rotator cuff repair