What is the impact of early rehabilitation following rotator cuff repairs on clinical and biomechanical outcomes? A randomised controlled trial

Background: The number of rotator cuff repairs performed worldwide is increasing every year. However, there are still controversies regarding when rehabilitation after surgery should start. Objectives: To assess and to compare clinical and biomechanical outcomes of patients who were randomised and allocated to early or conservative rehabilitation after rotator cuff repairs. Methods: Twenty patients were randomised to two treatment groups. The biomechanical assessments were performed before surgery and at three and six months, consisting of 3D kinematics and muscle activity from 5 muscles (upper trapezius, anterior deltoid, middle deltoid, posterior deltoid and biceps brachii) from six movement tasks. In addition, the Oxford Shoulder Score and EQ-5D-5L were also recorded. At 12 months an ultrasound scan was performed to check the repair integrity. Results: Overall, both groups had similar results for function and health-related quality of life. However, at six months patients in the early group had better range of motion (ROM) than those in the conservative group, especially for shoulder flexion (Early: median=152.1° vs Conservative: median=140.0°). The number of re-tear events was higher in the early group (5 vs 1), and of these only two patients reported symptoms at 12 months. Conclusion: Early rehabilitation may improve ROM but it does not seem to be superior to a conservative management in improving function and quality of life. In addition, more re-tear events were observed in the early group. However, the results should be interpreted with caution due to the small sample size