Postoperative mobilization after Rotator Cuff Repair: Sling versus nothing. A randomized prospective study

Abstract

Introduction Early-motion rehabilitation protocols after rotator cuff repair, gradually gained acceptance as they result in greater postoperative range of motion, pain relief, reduced stiffness, and earlier return to activities, compared to delayed motion rehabilitation. Negative impacts of early immobilization are unavoidable, and immobilization braces impair gait and cause falls, as well as adverse cardiovascular effects, especially when malpositionned. Methods We randomized 80 consecutive patients undergoing arthroscopic superior cuff repair (RCR) for small supraspinatus tears (> 3 cm) into 2 equal groups: no sling and sling-wearing groups. Patients in the sling-wearing group were asked to wear a sling for the first 4 postoperative weeks, while patients in the other group wore no brace. The latter group was asked not to perform active abduction. Overhead active-assisted mobilization was performed in both groups during the first 4 postoperative weeks followed by a progressive active mobilization. After surgery, patients were evaluated clinically at 1.5, 3 and 6 months, and using ultrasound at 6 months. Results Preoperative patient characteristics and function were not statistically different between the two groups. Patients without sling showed greater postoperative mobility at 6 weeks (active elevation (AE) 110.1 ± 31.9 vs. 97.0 ± 25.0; external rotation (ER) 23.5 ± 15.6 vs. 15.3 ± 14.6) and at 3 months of follow-up (AE, 139.0 ± 24.7 vs. 125.8 ± 24.4; internal rotation (IR) ?T12, 50% vs 27.5 %), compared to patients with sling. At 6 months, patients that wore slings reported lower VAS pain (0.8 ± 1.1 vs. 1.5 ± 1.6) as well as better SANE score (85.8 ± 10.7 vs. 79.4 ± 11.6) compared to patients that wore slings. No significant differences were observed between the two groups regarding postoperative ASES, bursitis, tendon healing or repair integrity. Discussion and conclusion Absence of postoperative sling after rotator cuff repair was associated with better postoperative outcomes, greater mobility, and lower pain.