背景:关节镜肩袖修复后开始被动或主动活动范围(ROM)的时机尚不清楚。这项系统评价和荟萃分析评估了关节镜肩袖修复后早期与延迟被动和主动ROM方案。这项研究的目的是系统地回顾早期主动/被动与延迟主动/被动术后关节镜肩袖修复康复方案的结果。
方法:对截至2022年4月发表的随机对照试验(RCT)进行了系统评价和荟萃分析,比较了关节镜肩袖修复后早期运动(EM)与延迟运动(DM)康复方案的部分和全厚度撕裂。主要结果是活动范围(前屈,外部旋转,内部旋转,外展),次要结局是Constant-Murley评分(CMS),单肩测试评分(SST评分)和视觉模拟评分(VAS)。
结果:本研究纳入了13个RCT,1,082名患者(7个RCT用于早期被动运动(EPM)与延迟被动运动(DPM)和早期主动运动(EAM)的7个RCT与延迟主动运动(DAM)。前屈曲(1.40,95%置信区间(CI),与DPM相比,EPM组中的0.55-2.25)和外展(2.73,95CI,0.74-4.71)更高。同样,EAM在前屈(1.57,95CI,0.62-2.52)和外旋(1.59,95CI,0.36-2.82)方面显示出优势,与DAM相比。EPM和DPM对外旋转没有区别,再撕率,CMS和SST评分。EAM和DAM的再撕率没有差异,绑架,CMS和VAS。
结论:与DAM和DPM方案相比,EAM和EPM均与更优的ROM相关。EAM和EPM对改善小到大尺寸泪液患者关节镜手术后的ROM既安全又有益。
BACKGROUND: The timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated early versus delayed passive and active ROM protocols following arthroscopic rotator cuff repair. The aim of this study is to systematically review the literature on the outcomes of early active/passive versus delayed active/passive postoperative arthroscopic rotator cuff repair rehabilitation protocols.
METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2022 comparing early motion (EM) versus delayed motion (DM) rehabilitation protocols after arthroscopic rotator cuff repair for partial and full-thickness tear was conducted. The primary outcome was range of motion (anterior flexion, external rotation, internal rotation, abduction) and the secondary outcomes were Constant-Murley score (CMS), Simple Shoulder Test Score (SST score) and Visual Analogue Scale (VAS).
RESULTS: Thirteen RCTs with 1,082 patients were included in this study (7 RCTs for early passive motion (EPM) vs. delayed passive motion (DPM) and 7 RCTs for early active motion (EAM) vs. delayed active motion (DAM). Anterior flexion (1.40, 95% confidence interval (CI), 0.55-2.25) and abduction (2.73, 95%CI, 0.74-4.71) were higher in the EPM group compared to DPM. Similarly, EAM showed superiority in anterior flexion (1.57, 95%CI, 0.62-2.52) and external rotation (1.59, 95%CI, 0.36-2.82), compared to DAM. There was no difference between EPM and DPM for external rotation, retear rate, CMS and SST scores. There was no difference between EAM and DAM for retear rate, abduction, CMS and VAS.
CONCLUSIONS: EAM and EPM were both associated with superior ROM compared to the DAM and DPM protocols. EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for the patients with small to large sized tears.