Rehabilitation protocols following rotator cuff repair: a meta-analysis of current evidence.

Abstract

Rotator cuff tears are a common shoulder pathology with an increasing incidence. The optimum post-operative rehab protocol remains unclear and can consist of either conservative rehabilitation or more aggressive early range-of-motion. Multiple studies have assessed these treatment protocols. This meta-analysis aims to compare post-operative clinical outcomes following either conservative or aggressive rehabilitation post rotator cuff repair. A systematic electronic literature search was undertaken using a number of databases. Eligible studies included randomized control trials published between January 2013 and April 2019 in English with patients having had received rotator cuff repair. Post-operative clinical outcomes considered included shoulder range-of-motion, overall function status (Costant-Murley score) and rates of rotator-cuff re-tear. Studies were evaluated for methodological quality in accordance with the Physiotherapy Evidence Database (PEDro) scale. Summarized pooled statistics were calculated using Review Manager (v5.3) software. A total of six randomized controlled trials were included. Standardized mean difference (SMD) in shoulder flexion, abduction and external rotation was not statistically significant at either 6 or 12 months post rotator cuff repair. Functional assessment suggests a slight benefit in Constant-Murley Score (SMD=1.77; 95% CI -3.93, 7.47) in aggressive treatment groups with no significant risk increase for cuff re-tear (RR=1.22; 95% CI 0.60, 2.47). This meta-analysis suggests there is no clear benefit of either rehabilitation protocol when considering range-of-motion, with a possible benefit in functional outcome at the cost of increased re-tear risk post aggressive rehabilitation. Both protocols have been shown to offer safe reproducible short- and long-term outcomes.