PURPOSE: To provide a synthesis of the highest-quality literature available comparing early passive motion (EPM) with strict sling immobilization during the first 4 to 6 weeks after surgery. METHODS The Medline, Cochrane, and Embase databases were searched for eligible studies. We reviewed 886 citations, and 5 randomized clinical trials (RCTs) (level II) met the inclusion criteria for meta-analysis. Four RCTs contributed to the analysis of range of motion, and 5 contributed to the analysis of retear rates. A single level IV study was available for qualitative review. Random-effects models were used for meta-analysis, computing mean differences for continuous variables and risk ratios for dichotomous variables. RESULTS: EPM resulted in improved shoulder forward flexion at 3 months (mean difference 14.70 degrees; 95% confidence interval (CI) 5.52 to 23.87 degrees; p = 0.002), 6 months (mean difference 4.31 degrees; 95% CI 0.17 to 8.45 degrees; p = 0.04), and 12 months (mean difference 4.18 degrees; 95% CI 0.36 to 8.00 degrees; p = 0.03). External rotation at the side was only superior with EPM at 3 months (mean difference 10.43 degrees; 95% CI 4.51 to 16.34 degrees; p = 0.0006). Rotator cuff retear rates (16.3% for immobilization versus 21.1% for EPM; risk ratio 0.82; 95% CI 0.57 to 1.20; p = 0.31) were not significantly different between EPM and immobilization at a minimum of 1 year of follow-up. CONCLUSIONS A small number of RCTs with low to moderate risks of bias are currently available. Meta-analysis suggests that after primary arthroscopic rotator cuff repair of small to medium tears, EPM results in 15 degrees of improved forward flexion at 3 months and approximately 5 degrees at 6 and 12 months. External rotation is improved by 10 degrees with EPM at 3 months only. The clinical importance of these differences has yet to be determined. Retear rates at a minimum of 1 year of follow-up are not clearly affected by type of rehabilitation. LEVEL OF EVIDENCE: Level II, meta-analysis of level II studies and qualitative review of level IV study.
Copyright by Arthroscopy Association of North America.

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