The Effect of Shoulder Immobilization Position on Outcomes Following Rotator Cuff Repair: A Scoping Review
Bibliographic record
Abstract
Introduction: There has been growing interest in determining the influence of post-operative immobilization posture and rehabilitation protocol on healing rates and clinical outcomes. Current consensus calls for the use of an immobilization device post-operatively, which commonly comes in the form of a standard sling or an abduction brace with the arm positioned in varying degrees of abduction. There is a lack of high-level evidence in the literature to recommend one type of immobilization device or arm position over another. Objectives: This study aimed to summarize the current clinical and biomechanical evidence for the optimal postoperative positioning and bracing of the arm following arthroscopic rotator cuff repair. Methods: A comprehensive search of the electronic databases EMBASE, MEDLINE, and PubMed was performed using a combination of the following keywords and medical subject heading (MeSH) terms: ‘arthroscopic’, ‘rotator cuff repair’, ‘sling’, ‘brace’ and ‘immobilization’. This systematic review was conducted following the Preferred Reporting for Systematic Reviews and Meta-analysis (PRIMSA) guidelines. Two reviewers performed an independent assessment of the methodological quality of each eligible clinical study using the Methodological Index for Non-Randomized Studies (MINORS). Results: Based on current biomechanical evidence, placement of the arm into an abducted position following rotator cuff repair was found to be favorable. An abduction angle of 30° was associated with lower strain on the repair while maintaining appropriate contact pressure at the footprint. However, the use of an abduction brace did not result in a clinically significant improvement in long-term PROM, ROM, and re-tear rates when compared to a traditional sling in clinical studies. Conclusion: Despite observing favorable outcomes with abduction bracing after rotator cuff repair in biomechanical studies these findings were not reproduced in clinical studies. However, current clinical studies are comprised of small sample sizes, varying tear sizes, and significant heterogeneity in both, the degree of abduction and forearm rotation. Future studies should be directed towards prospectively investigating the effect of immobilization position among patients with similar rotator cuff tear sizes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.100 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.010 |
| Bibliometrics | 0.015 | 0.016 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".