Sling versus abduction brace shoulder immobilization after arthroscopic rotator cuff repair

Key points

1. 01Across 4 randomized trials (224 patients), abduction brace and sling immobilization produced no significant difference in shoulder function, pain, or tendon healing.
2. 02Constant-Murley function scores were statistically equivalent at 3, 6, and 12 months.
3. 03Visual analog pain scores were statistically equivalent at 1, 3, 6, and 12 weeks.
4. 04Retear rates did not differ between the groups at 3 months.
5. 05Evidence is limited by only 4 small trials, all rated Level 2, with high heterogeneity for some function outcomes.

How it was conducted

Design

Systematic review and meta-analysis of randomized controlled trials (PRISMA), searching PubMed, MEDLINE, and Embase from inception to April 2022

Comparison

Abduction brace versus sling for shoulder immobilization after arthroscopic rotator cuff repair (single-row, double-row, or suture-bridge fixation)

Included studies

4 RCTs in qualitative analysis; 3 RCTs pooled in the meta-analysis; all rated Level 2 evidence

Participants

224 patients total, 112 in the abduction brace group and 112 in the sling group

Outcomes

Constant-Murley score, visual analog scale for pain, and retear rate (retears assessed by ultrasound)

Analysis

Weighted mean differences for continuous outcomes, risk ratio for retears, heterogeneity by I2, Cochrane risk-of-bias tool

What they found

• No difference in Constant-Murley score at 3 months (WMD, 0.26 [95% CI, -1.30 to 1.83]; P = .74; I2 = 84%), 6 months (WMD, 1.91 [95% CI, -0.17 to 4.00]; P = .07; I2 = 85%), or 12 months (WMD, 0.55 [95% CI, -1.37 to 2.47]; P = .57; I2 = 0%).
• No difference in VAS pain score at 1 week (WMD, 0.10 [95% CI, -0.20 to 0.41]; P = .51; I2 = 0%), 3 weeks (WMD, -0.12 [95% CI, -0.34 to 0.10]; P = .29; I2 = 0%), 6 weeks (WMD, -0.12 [95% CI, -0.30 to 0.06]; P = .20; I2 = 0%), or 12 weeks (WMD, -0.13 [95% CI, -0.27 to 0.02]; P = .09; I2 = 18%).
• No difference in retear rate at 3 months (RR, 0.63 [95% CI, 0.09 to 4.23]; P = .64).
• Of 1572 studies retrieved, 4 RCTs met inclusion criteria; randomization was reported in 3 studies and allocation concealment was adequate in 3 studies.

Limitations

• Only 4 small trials totaling 224 patients were included, and all were rated Level 2 evidence rather than higher quality.
• High heterogeneity (I2 of 84% and 85%) for the Constant-Murley score at 3 and 6 months reflects varied outcome measures and inclusion criteria across studies.
• Only 2 trials reported retear rates, and the 3-month follow-up for retears is too short to capture later healing failures.
• Range of motion could not be pooled because one trial reported it as medians and ranges.

Why it matters

For patients

If you have had arthroscopic rotator cuff repair, a simpler sling is likely to work as well as a bulky abduction brace for your recovery and pain.

For clinicians

This evidence does not support routine use of an abduction brace over a sling after arthroscopic rotator cuff repair, though trials are few and small.

For readers

The current randomized evidence shows no functional or healing advantage for abduction bracing, but more high-quality trials are needed to confirm this.