Abstract
To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24months following arthroscopic rotator cuff (RC) repair. A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n= 103; self-weaned from sling and performed pain-free active ROM during the first 6weeks) or SR (n= 103; wore a sling for 6weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6weeks and 3, 6, 12, and 24months postoperatively by a blinded assessor. At 6, 12, and 24months, strength was reassessed. At 12months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24months. At 6weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24months, there were no group differences in ROM after 6weeks (P > .08), and pain (P > .06), strength (P= .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6weeks following arthroscopic RC repair. Level I, high-quality randomized controlled trial.
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