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Assessment of several postoperative protocols after rotator cuff repair: A network meta-analysis
Pierre-Alban Bouché1, Nicolas Gaujac1, Jules Descamps2
1Orthopaedic Department, Lariboisière Hospital, AP-HP, 2, rue Ambroise Paré, 75010 Paris, France.
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.