Bandara Udara, An Vincent V G, Imani Sahand, Nandapalan Haren, Sivakumar Brahman S
Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia.
Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Dec;91(12):2773-2779. doi: 10.1111/ans.17213. Epub 2021 Sep 28.
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.
肩袖撕裂是一种常见的肩部病变，发病率呈上升趋势。最佳的术后康复方案仍不明确，可包括保守康复或更积极的早期活动范围训练。多项研究评估了这些治疗方案。本荟萃分析旨在比较肩袖修复术后保守或积极康复后的临床结果。
使用多个数据库进行系统的电子文献检索。符合条件的研究包括2013年1月至2019年4月期间以英文发表的随机对照试验，患者接受了肩袖修复。考虑的术后临床结果包括肩部活动范围、整体功能状态（Constant-Murley评分）和肩袖再次撕裂率。根据物理治疗证据数据库（PEDro）量表对研究的方法学质量进行评估。使用Review Manager（v5.3）软件计算汇总统计数据。
共纳入六项随机对照试验。肩袖修复术后6个月或12个月时，肩部前屈、外展和外旋的标准化平均差（SMD）无统计学意义。功能评估表明，积极治疗组在Constant-Murley评分上有轻微益处（SMD = 1.77；95% CI -3.93，7.47），且袖带再次撕裂的风险没有显著增加（RR = 1.22；95% CI 0.60，2.47）。
本荟萃分析表明，在考虑活动范围时，两种康复方案均无明显益处，积极康复可能在功能结果方面有益，但代价是再次撕裂风险增加。两种方案均已证明可提供安全可重复的短期和长期结果。
