Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Sheps, David M; Silveira, Anelise; Beaupré, Lauren A; Styles-Tripp, Fiona; Balyk, Robert; Lalani, Aleem; Glasgow, Robert E.; Bergman, Joseph; Bouliane, Martin

doi:10.1016/j.arthro.2018.10.139

Cited by 68 publications

(109 citation statements)

References 30 publications

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“…The method of immobilisation after rotator cuff repair was variable. The majority of the RCTs (3, 19, 20, 23-30)(11/20, 55%) reported the use of a standard sling, six RCTs (18, 21, 22, 31-33) used a sling with an abduction component and one RCT (34) used a standard sling for the early group and a sling with an abduction component for the delayed group. The time in the sling was also variable; eight RCTs (40%) (18, 21, 23-26, 29, 32) used a six-week period for both groups.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Mazuquin

Moffatt

Gill

et al. 2021

Preprint

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Objective: To investigate the effectiveness of early rehabilitation compared with delayed/standard rehabilitation after rotator cuff repair for pain, function, range of movement, strength, and repair integrity. Design: Systematic review and meta-analyses. Methods: We searched databases and included randomised controlled trials (RCTs) comparing early with delayed/standard rehabilitation for patients undergoing rotator cuff repair surgery. We assessed risk of bias of the RCTs using the Cochrane RoB 2 tool. Results: Twenty RCTs, with 1841 patients, were included. The majority of the RCTs were of high or unclear risk of overall bias. We found substantial variations in the rehabilitation programmes, time in the sling and timing of exercise progression. We found no statistically significant differences for pain and function at any follow-up except for the outcome measure Single Assessment Numeric Evaluation at six months (MD: 6.54; 95%CI: 2.24-10.84) in favour of early rehabilitation. We found statistically significant differences in favour of early rehabilitation for shoulder flexion at six weeks (MD: 7.36; 95%CI: 2.66-12.06), three (MD: 8.45; 95%CI: 3.43-13.47) and six months (MD: 3.57; 95%CI: 0.81-6.32) and one year (MD: 1.42; 95%CI: 0.21-2.64) and similar differences for other planes of movement. In terms of repair integrity at one year, regarding early mobilisation, the number needed to harm was 651. Discussion: Current approaches to early mobilisation, based largely on early introduction of passive movement, did not demonstrate significant differences in most clinical outcomes, although we found statistically significant differences in favour of early rehabilitation for range of movement. Importantly, there were no differences in repair integrity between early and delayed/standard rehabilitation. Most rehabilitation programmes did not consider early active movement as soon as the patient feels able. With ongoing variation in rehabilitation protocols there remains a need for large high quality RCT to inform the optimal approach to rehabilitation after rotator cuff repair surgery.

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Section: Resultsmentioning

confidence: 99%

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Mazuquin

Moffatt

Gill

et al. 2021

Preprint

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“…Currently, the only clear consensus appears to be the recognition that high-quality research is needed to better inform practice and optimise clinical outcomes for patients following SA (Bullock et al, 2019;Kirsch & Namdari, 2020). Other areas of rehabilitation following orthopaedic surgery, for example, rehabilitation following rotator cuff repair, have evolved over a number of years (Littlewood et al, 2019;Sheps et al, 2015;Sheps et al, 2019). Whether there is now further opportunity to develop rehabilitation approaches, following SA, to enhance clinical outcomes and/or reduce postoperative restrictions, for example, sling immobilisation, is a question to be addressed.…”

Section: Discussionmentioning

confidence: 99%

Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information

Littlewood

Morgan

Pitt

et al. 2020

Musculoskeletal Care

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Introduction The prevalence of shoulder arthroplasty (SA) is rising, but there is limited research evaluating rehabilitation following SA and whether there is an optimal approach remains unknown. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following SA as a platform for conducting much needed further research. Methods Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following SA, for example, duration of immobilisation. One reviewer extracted data, and a second reviewer verified this. Ethical approval Not required. Results Forty‐three PIS from 40 Trusts were identified. Twenty‐four referred to more than one type of arthroplasty (anatomic, reverse and hemiarthroplasty) but did not describe different approaches to rehabilitation based on prosthesis type. Twenty‐five PIS provided some instruction regarding movement restrictions, which varied considerably. All PIS referred to postoperative immobilisation, typically with a sling, with median duration of 4 weeks (range 0 to 8). Thirty‐four PIS reported commencing passive exercise immediately. Median time to commencing active exercise was 4 weeks (range 1 to 6) and 5 weeks (range 1 to 16) for resisted exercise. Median time expected to return to driving was 6 weeks (range 3 to 12) and general work 12 weeks (range 3 to 26). Conclusion This study has highlighted significant heterogeneity between rehabilitation approaches following SA, not previously reported in the United Kingdom, with a lack of specific rehabilitation PIS for different prosthesis types. Our results will facilitate evaluation of rehabilitation strategies in future research.

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“…Furthermore, there is little evidence supporting the fact that early mobilization improves functional outcomes, ROM, pain, and retear rates when compared with conservative rehabilitation. [11][12][13][14] In another study, Li et al 15 determined that at long-term follow-up, early passive motion may result in lower rates of tendon healing when it comes to large-sized tendon tears. Thus, with such a low consensus of protocols in this study (91.7%) prohibiting early postoperative mobilization (no immediate restriction on PROM postoperatively), it is evident that further research on proper rehabilitation is needed.…”

Section: Discussionmentioning

confidence: 99%

A Review of Online Rehabilitation Protocols Designated for Rotator Cuff Repairs

Coda

Cheema

Hermanns

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare publicly available rehabilitation protocols designated for rotator cuff (RTC) repairs published online by academic residency programs and private practice institutions. Methods: A systematic electronic search using the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) was performed for RTC repair rehabilitation protocols. Private practice programs with published rehabilitation protocols that were discovered during the Google search were also included for review, but no comprehensive search for private practice protocols was performed. The main exclusion criteria consisted of noneEnglish-language protocols and protocols without any of the time-based components in question. Included protocols were assessed independently based on the specified RTC tear size (small [1 cm], medium [1-4 cm], large or massive [5 cm], or no mention of size). Protocols were compared based on the inclusion, exclusion, and timing of certain rehabilitation components. Results: A total of 96 rehabilitation protocols were included for review, from 39 academic institutions and 28 private practice programs. Specific instructions for concomitant biceps tenodesis were included in 26 protocols (27.1%). Of the 96 protocols, 88 (91.7%) did not place restrictions on early postoperative passive range of motion (PROM) of the shoulder. Isolated PROM with restrictions on active range of motion was most commonly recommended for the first 4 or 6 weeks postoperatively (80.2%). Use of a sling or immobilizer was most frequently recommended for the first 4 or 6 weeks postoperatively (78.1%). Wide variation was noted in recommendations for returning to resistance strengthening, with the highest incidence being 27 protocols recommending returning at 12 weeks (28.1%); this further varied based on the size of the tear. A total of 21 protocols (21.9%) recommended the use of cryotherapy postoperatively. Conclusions: Although certain rehabilitation components were common, such as duration of PROM and sling or immobilizer use, a large degree of variation remains among published rehabilitation protocols after RTC repair, and this variability is still seen even when subdividing by the size or severity of the RTC tear. Clinical Relevance: Rehabilitation after RTC repair is crucial to patient outcomes. This study summarizes the variability among online rehabilitation protocols for RTC repair in the United States and emphasizes the importance of appropriate rehabilitation after RTC surgery.

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Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Cited by 68 publications

References 30 publications

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information

A Review of Online Rehabilitation Protocols Designated for Rotator Cuff Repairs

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