Houck Darby A, Kraeutler Matthew J, Schuette Hayden B, McCarty Eric C, Bravman Jonathan T
University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
Am J Sports Med. 2017 Oct;45(12):2911-2915. doi: 10.1177/0363546517692543. Epub 2017 Mar 13.
Previous meta-analyses have been conducted to compare outcomes of early versus delayed motion after rotator cuff repair.
To conduct a systematic review of overlapping meta-analyses comparing early versus delayed motion rehabilitation protocols after rotator cuff repair to determine which meta-analyses provide the best available evidence.
Systematic review.
A systematic review was performed by searching PubMed and Cochrane Library databases. Search terms included "rotator cuff repair," "early passive motion," "immobilization," "rehabilitation protocol," and "meta-analysis." Results were reviewed to determine study eligibility. Patient outcomes and structural healing were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence.
Seven meta-analyses containing a total of 5896 patients met the eligibility criteria (1 Level I evidence, 4 Level II evidence, 2 Level III evidence). None of these meta-analyses found immobilization to be superior to early motion; however, most studies suggested that early motion would increase range of motion (ROM), thereby reducing time of recovery. Three of these studies suggested that tear size contributed to the choice of rehabilitation to ensure proper healing of the shoulder. A study by Chan et al in 2014 received the highest QUOROM and Oxman-Guyatt scores, and therefore this meta-analysis appeared to have the highest level of evidence. Additionally, a study by Riboh and Garrigues in 2014 was selected as the highest quality study in this systematic review according to the Jadad decision algorithm.
The current, best available evidence suggests that early motion improves ROM after rotator cuff repair but increases the risk of rotator cuff retear. Lower quality meta-analyses indicate that tear size may provide a better strategy in determining the correct rehabilitation protocol.
以往已进行荟萃分析以比较肩袖修复术后早期与延迟活动的结果。
对比较肩袖修复术后早期与延迟活动康复方案的重叠荟萃分析进行系统评价，以确定哪些荟萃分析提供了最佳现有证据。
系统评价。
通过检索PubMed和Cochrane图书馆数据库进行系统评价。检索词包括“肩袖修复”“早期被动活动”“固定”“康复方案”和“荟萃分析”。对结果进行审查以确定研究的纳入标准。从这些荟萃分析中提取患者结局和结构愈合情况。使用Oxman-Guyatt和荟萃分析报告质量（QUOROM）系统评估荟萃分析的质量。然后使用Jadad决策算法确定哪些荟萃分析提供了最佳证据水平。
七项荟萃分析共纳入5896例患者，符合纳入标准（1项I级证据、4项II级证据和2项III级证据）。这些荟萃分析均未发现固定优于早期活动；然而，大多数研究表明，早期活动会增加活动范围（ROM），从而缩短恢复时间。其中三项研究表明，撕裂大小有助于康复方案的选择，以确保肩部的正确愈合。Chan等人在2014年进行的一项研究获得了最高的QUOROM和Oxman-Guyatt评分，因此该荟萃分析似乎具有最高的证据水平。此外，根据Jadad决策算法，Riboh和Garrigues在2014年进行的一项研究被选为该系统评价中质量最高的研究。
目前最佳现有证据表明，早期活动可改善肩袖修复术后的ROM，但会增加肩袖再次撕裂的风险。质量较低的荟萃分析表明，撕裂大小可能为确定正确的康复方案提供更好的策略。
