Introduction

There are presently 3 postoperative protocols after rotator cuff repair: strict immobilization, passive motion and early active motion. There is no consensus as to which is to be preferred. The aim of the present study was to conduct a network meta-analysis to determine whether one particular protocol shows advantages in terms of healing, motion, clinical scores and complications.

Methods

A search of the PubMed, Embase and Central databases extracted all randomized controlled trials (RCTs) comparing at least 2 protocols. Eighteen RCTs were thus included, for a total 1704 patients (mean age, 58.1 years) and 1726 shoulders.

Results

Strict immobilization was associated with lower flexion at 1 year than passive motion (mean difference, 2.66 [95% CI, 0.42-6.20]) and active motion (mean difference, 3.76 [95% CI, 0.17-7.80]). There were no differences between protocols for external rotation, healing at 1 year or Constant, ASES and STT scores in the short and medium terms. There was no difference in complications rate.

Conclusion

Early motion, whether passive or active, leads to greater flexion than does strict immobilization. No other differences were found between the protocols. Taking certain prognostic factors (lesion size, patient age, activity level, etc.) into account could guide specific rehabilitation according to type of lesion.

Level of evidence

I, network meta-analysis.

中文翻译：

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肩袖修复后几种术后方案的评估：网络荟萃分析

介绍

目前肩袖修复术后有3种方案：严格制动、被动运动和早期主动运动。对于哪个是首选，没有达成共识。本研究的目的是进行网络荟萃分析，以确定一种特定方案是否在愈合、运动、临床评分和并发症方面显示出优势。

方法

对 PubMed、Embase 和中央数据库的搜索提取了所有比较至少 2 个方案的随机对照试验 (RCT)。因此纳入了 18 项随机对照试验，共计 1704 名患者（平均年龄 58.1 岁）和 1726 个肩膀。

结果

与被动运动（平均差 2.66 [95% CI，0.42-6.20]）和主动运动（平均差 3.76 [95% CI，0.17-7.80]）相比，严格固定与 1 年时屈曲度较低相关。短期和中期的外旋方案、1 年愈合或 Constant、ASES 和 STT 评分方案之间没有差异。并发症发生率没有差异。

结论

早期运动，无论是被动还是主动，都会导致比严格固定更大的屈曲。协议之间没有发现其他差异。考虑某些预后因素（病变大小、患者年龄、活动水平等）可以根据病变类型指导具体康复。

证据等级

I，网络荟萃分析。