BACKGROUND: Postoperative rehabilitation has been shown to affect healing of the rotator cuff after surgical repair. However, it is unknown whether an early or delayed rehabilitation protocol is most beneficial for healing. PURPOSE: To determine whether early versus delayed passive range of motion (PROM) affects rotator cuff (RC) retear rates after surgery. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review of the literature published between January 2003 and February 2014 was conducted. Retear rates were compared for early (within 1 week after surgery) versus delayed (3 to 6 weeks after surgery) PROM using Chi2 or Fisher exact tests as well as relative risks (RR) and 95% CIs. In the first analysis, data from evidence level 1 studies that directly compared early versus delayed PROM were pooled; and in the second analysis, data from level 1 to 4 studies that did not directly compare early versus delayed PROM were pooled. The second analysis was stratified by tear size and repair method. RESULTS: Twenty-eight studies (1,729 repairs) were included. The first analysis of level 1 studies did not reveal a significant difference in retear rates for early (13.7%) versus delayed (10.5%) PROM (p = 0.36; RR 1.30 (95% CI 0.74 to 2.30)). The second analysis revealed that for <= 3 cm tears, the risk of retear was lower for early versus delayed PROM for transosseous (TO) plus single-row anchor (SA) repairs (18.7% versus 28.2%, p = 0.02; RR 0.66 (95% CI 0.47 to 0.95)). For >= 5 cm tears, the risk of retear was greater for early versus delayed PROM for double-row anchor (DA) repairs (56.4% versus 20%, p = 0.002; RR 2.82 (95% CI 1.31 to 6.07)) and for all repair methods combined (52.2% versus 22.6%, p = 0.01; RR 2.31 (95% CI 1.16 to 4.61)). There were no statistically significant associations for tears measuring <= 1 cm, 1 to 3 cm, 3 to 5 cm, and >= 3 cm. CONCLUSION: Evidence is lacking with regard to the optimal timing of PROM after RC repair; however, this study suggests that tear size may be influential.

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