Background:

Superior capsular reconstruction (SCR) is an option for patients with massive or irreparable rotator cuff tears.

Purpose:

To describe the literature on rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the introduction of motion.

Study Design:

Scoping review; Level of evidence, 4.

Methods:

We conducted a scoping review of articles published on PubMed, Ovid, Embase, and the Cochrane Library from inception to October 2020. The methodological index for non-randomized studies (MINORS) was used to assess the individual studies. For each article, we summarized the study characteristics, patient demographics, and rehabilitation protocols after SCR: duration of immobilization, initiation of passive range of motion (ROM), active-assisted ROM, active ROM, strengthening, and return to activities. In a subgroup narrative analysis, rehabilitation protocols were stratified by graft type: autograft versus nonautograft (xenograft, allograft, and synthetic).

Results:

A total of 21 studies met the search criteria. Six studies had level 3 evidence and 15 had level 4 evidence; 16 studies were considered high quality according to the MINORS score. After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks. Of the 21 studies, 7 (33%) started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for patients with nonautograft versus autograft (χ² = 225; P < .001). There was a high level of heterogeneity in the rehabilitation protocols after SCR.

Conclusion:

The majority of published protocols were descriptive. At present, there is little agreement on the published rehabilitation guidelines after SCR, precluding specific clinical best practice suggestions. Although there was a tendency of recommending early motion in nonautograft cases, the optimal protocols based on graft healing and functional outcomes require further verification based on the clinical outcomes from high-quality studies.

中文翻译：

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无法修复的肩袖撕裂上囊重建术后康复方案的范围审查

背景：

对于有大量或无法修复的肩袖撕裂的患者，上层关节囊重建 (SCR) 是一种选择。

目的：

描述有关肩袖撕裂 SCR 后康复方案的文献，重点是引入运动的时机。

学习规划：

范围审查；证据水平，4。

方法：

我们对 PubMed、Ovid、Embase 和 Cochrane 图书馆从成立到 2020 年 10 月发表的文章进行了范围审查。使用非随机研究的方法学索引 (MINORS) 来评估各个研究。对于每篇文章，我们总结了 SCR 后的研究特征、患者人口统计数据和康复方案：固定时间、被动运动范围 (ROM) 的开始、主动辅助 ROM、主动 ROM、加强和恢复活动。在亚组叙述分析中，康复方案按移植物类型分层：自体移植与非自体移植（异种移植、同种异体移植和合成）。

结果：

共有 21 项研究符合检索条件。6 项研究有 3 级证据，15 项有 4 级证据；根据 MINORS 评分，16 项研究被认为是高质量的。SCR 后，建议使用外展固定器持续 3 至 6 周。在 21 项研究中，7 项（33%）在第一周开始被动 ROM，5 项报告在长达 6 周的时间内严格固定不动。报告恢复运动时间的所有 8 项研究都建议将恢复时间推迟到术后至少 6 个月。非自体移植患者与自体移植患者较早推荐被动 ROM（χ ² = 225；P < .001）。SCR 后的康复方案存在高度异质性。

结论：

大多数已发布的协议都是描述性的。目前，关于 SCR 后公布的康复指南几乎没有达成一致意见，排除了具体的临床最佳实践建议。尽管在非自体移植病例中存在推荐早期运动的趋势，但基于移植愈合和功能结果的最佳方案需要基于高质量研究的临床结果进一步验证。