Comparative analysis of early versus delayed rehabilitation protocols following rotator cuff repair: A randomized controlled trial.

Abstract

The optimal timing for initiating shoulder motion after rotator cuff repair remains controversial, balancing re-tear risk against stiffness from immobilization. This trial compared clinical and structural outcomes of early versus delayed rehabilitation. From March 2024 to February 2025, 120 patients undergoing arthroscopic (single-row) or open (double-row) repair of full-thickness tears were randomized to an early-motion group (EMG; n = 60) or a delayed-motion group (DMG; n = 60). The EMG began supervised passive forward flexion and abduction within 24 h postoperatively. The DMG underwent strict immobilization for 6 weeks before starting identical rehabilitation. Primary outcomes at 6 months included pain (VAS), function (UCLA score), active range of motion (ROM), and re-tear rate on MRI (Sugaya IV/V). Secondary outcomes covered satisfaction, complications, and return to activities. Demographic, clinical, and surgical factors were analyzed. At 6 months, the EMG showed significantly lower pain (VAS: 1.7 ± 0.8 vs. 2.9 ± 1.1; p = 0.02), higher function (UCLA: 33.7 ± 2.1 vs. 29.4 ± 3.3; p = 0.01), greater ROM, and lower stiffness (5 % vs. 15 %; p = 0.03). Re-tear rates did not differ significantly (EMG: 3.3 % vs. DMG: 1.7 %; p = 0.56). All three re-tears occurred in patients with large tears (>3 cm) and high-grade fatty infiltration (Goutallier ≥3). Multivariate analysis confirmed early motion as an independent predictor of better outcomes. Surgical technique did not alter the primary findings. Supervised early passive motion is safe and superior to delayed immobilization, providing better functional recovery and lower stiffness without increasing re-tear risk. However, patients with large tears and advanced fatty infiltration represent a high-risk subgroup, necessitating personalized, cautious rehabilitation. Therapeutic Level I.