Gallagher Brian P, Bishop Meghan E, Tjoumakaris Fotios P, Freedman Kevin B
Jefferson Medical College , Philadelphia, PA , USA.
Phys Sportsmed. 2015 May;43(2):178-87. doi: 10.1080/00913847.2015.1025683. Epub 2015 Mar 22.
Early passive range of motion (ROM) following arthroscopic cuff repair is thought to decrease postoperative stiffness and improve functionality. However, early aggressive rehabilitation may compromise repair integrity. Our purpose was to perform a systematic review to determine if there are differences between early and delayed rehabilitation after arthroscopic rotator cuff repair in terms of clinical outcomes and healing.
We performed a literature search with the terms 'arthroscopic rotator cuff', 'immobilization', 'early', 'delayed', 'late', and 'rehabilitation' using PubMed, Cochrane Central Register of Controlled Trials, and EMBASE. Selection criteria included: level I/II evidence ≤ 6 months in duration, comparing early versus delayed rehabilitation following arthroscopic repair. Data regarding demographics, sample sizes, duration, cuff pathology, surgery, rehabilitation, functional outcomes, pain, ROM and anatomic assessment of healing were analyzed. PRIMSA criteria were followed.
We identified six articles matching our criteria. Three reported significantly increased functional scores within the first 3-6 months with early rehabilitation compared to the delayed group, only one of which continued to observe a difference at a final follow-up of 15 months. Four articles showed improved ROM in the first 3-6 months post-operatively with early rehabilitation. One noted transient differences in pain scores. Only one study noted significant differences in ROM at final follow-up. No study reported any significant difference in rates of rotator cuff re-tear. However, two studies noted a trend towards increased re-tear with early rehabilitation that did not reach significance. This was more pronounced in studies including medium-large tears.
Early rehabilitation after arthroscopic cuff repair is associated with some initial improvements in ROM and function. Ultimately, similar clinical and anatomical outcomes between groups existed at 1 year. While there was no significant difference between groups in anatomic failure of the repaired cuff, there may be a trend towards increased re-tear with larger tears.
关节镜下肩袖修复术后早期进行被动活动度（ROM）训练被认为可减少术后僵硬并改善功能。然而，早期积极的康复训练可能会影响修复的完整性。我们的目的是进行一项系统评价，以确定关节镜下肩袖修复术后早期康复与延迟康复在临床结局和愈合方面是否存在差异。
我们使用PubMed、Cochrane对照试验中心注册库和EMBASE，以“关节镜下肩袖”“固定”“早期”“延迟”“晚期”和“康复”为关键词进行文献检索。选择标准包括：一级/二级证据，持续时间≤6个月，比较关节镜修复术后早期康复与延迟康复。分析了有关人口统计学、样本量、持续时间、肩袖病理、手术、康复、功能结局、疼痛、活动度和愈合的解剖学评估的数据。遵循PRISMA标准。
我们确定了6篇符合我们标准的文章。3篇报告称，与延迟康复组相比，早期康复组在最初3至6个月内功能评分显著提高，其中只有1篇在15个月的最终随访中仍观察到差异。4篇文章显示，早期康复组术后最初3至6个月活动度有所改善。1篇指出疼痛评分存在短暂差异。只有1项研究在最终随访时指出活动度存在显著差异。没有研究报告肩袖再次撕裂率有任何显著差异。然而，2项研究指出早期康复有再次撕裂增加的趋势，但未达到显著水平。在包括中大型撕裂的研究中，这种趋势更为明显。
关节镜下肩袖修复术后早期康复与活动度和功能的一些初步改善相关。最终，两组在1年时的临床和解剖学结局相似。虽然修复的肩袖在解剖学失败方面两组之间没有显著差异，但对于较大的撕裂，可能有再次撕裂增加的趋势。
