Avalilação PREreview de Effectiveness of early versus delayed rehabilitation following rotator cuff repair: systematic review and meta-analyses

Short Summary of Main Findings This systematic review and meta-analysis (preprint Feb 2021; published in PLOS ONE May 2021) included 20 RCTs with 1,841 patients comparing early rehabilitation (typically starting passive motion within days/weeks) versus delayed/standard rehabilitation (immobilization in sling for 4–6 weeks before active motion) after rotator cuff repair.

Key results:

• No clinically or statistically meaningful differences in pain or most function outcomes at any time point (except a small benefit on Single Assessment Numeric Evaluation at 6 months: MD 6.54, 95% CI 2.24–10.84).

• Range of motion recovered significantly faster with early rehab (e.g., flexion MD +7.36° at 6 weeks, +8.45° at 3 months, +3.57° at 6 months, +1.42° at 1 year), with similar small benefits in other planes.

• No increased risk of re-tear (OR 1.05, 95% CI 0.64–1.75).

• No differences in strength or complications.

Rehabilitation protocols varied widely, and most “early” programs still relied on cautious passive motion rather than active loading.

How This Work Has Moved the Field Forward It updated and strengthened earlier reviews by adding eight new RCTs, confirming that early mobilization leads to faster ROM recovery without compromising tendon healing. This challenged overly conservative “protect the repair” approaches and supported earlier movement, influencing post-operative guidelines and reducing unnecessary prolonged immobilization in clinical practice.

Major Issues

• Most included RCTs had high or unclear risk of bias (Cochrane RoB 2).

• Substantial clinical heterogeneity in rehabilitation protocols (sling time, exercise progression, passive vs active), limiting strong recommendations.

• Small mean differences in ROM, unlikely to be clinically important for most patients.

• No large, high-quality trials testing truly progressive early active rehabilitation.

Minor Issues

• Limited data on patient-reported function at longer-term follow-up (>1 year).

• Strength outcomes under-reported across studies.

• No cost-effectiveness or return-to-work analysis.

Competing interests

The author declares that they have no competing interests.

Use of Artificial Intelligence (AI)

The author declares that they did not use generative AI to come up with new ideas for their review.