Effects of early exercise and immobilization after arthroscopic rotator cuff repair surgery: a systematic review and meta-analysis of randomized controlled trials

Early exercise is a physical adjuvant therapy that begins on day 1 postoperatively. It prevents postoperative stiffness, fatty infiltration, muscle atrophy and loss of range of motion. Usually, use of a brace fixation that immobilizes the shoulder in 30° of abduction during the postoperative rehabilitation period reduces tension on the repaired tendon, which improves tendon-bone healing. To investigate the effect of early exercise and brace fixation on postoperative recovery after arthroscopic rotator cuff repair by systematic review, thereby providing evidence-based evidence for clinical practice.

Chinese and English databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang database, and VIP database) were searched by keywords until November 15, 2024. Randomized controlled studies comparing early exercise versus brace fixation after arthroscopic rotator cuff repair surgery were included, along with an evaluation of such studies using the Cochrane Collaboration risk assessment tool. Afterward, the effect of the intervention on the visual analogue scale (VAS) for pain, function, shoulder range of motion (forward flexion, abduction, internal rotation, external rotation), and postoperative complications (stiffness, re-tear) was evaluated based on a fixed or random effects model.

Eleven high-quality randomized controlled studies were included. Compared with brace fixation, early exercise improved the range of motion of the subjects' shoulders. Compared with brace fixation, shoulder flexion (WMD of 6 weeks = 10.57, 95% CI: 1.30, 19.84, WMD of 3 months = 12.39, 95% CI: 7.51, 17.27, WMD of 6 months = 2.88, 95% CI: 1.02, 4.73, WMD of 1 year = 2.59, 95% CI: 0.40, 4.77) and shoulder abduction (WMD of 6 weeks = 13.17, 95% CI: 9.80, 16.55, respectively). The improvement degree of WMD = 2.28 in 6 months and internal rotation (WMD = 5.08, 95% CI: 3.16, 7.01, in 6 weeks and WMD = 8.23, 95% CI: 4.23, 12.23, in 3 months) was statistically different. Early exercise also reduced the risk of postoperative stiffness (RR = 0.34; 95%CI:0.19, 0.60). However, compared with brace fixation, there was no statistical difference in pain score (WMD = 0.05, 95% CI:0.09, 0.18) and shoulder joint recovery score (SMD = 0.05, 95% CI: 0.12, 0.03).

Early exercise can improve the range of motion of early shoulder joint and reduce the risk of postoperative stiffness, but the effect of pain and function improvement is not obvious, which can play a positive role in postoperative rehabilitation of patients, but it needs more comprehensive research and improvement to guide clinical practice.