Sling Versus Abduction Brace Shoulder Immobilization After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis

BACKGROUND: The optimal immobilization position of the shoulder after rotator cuff repair is controversial. PURPOSE: To compare the clinical outcomes and incidence of retears after arthroscopic rotator cuff repair between patients who used an abduction brace versus a sling for postoperative shoulder immobilization. STUDY DESIGN: Systematic review; Level of evidence, 1. METHODS: This systematic review and meta-analysis was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the PubMed, MEDLINE, and Embase electronic databases for randomized controlled trials (RCTs) that compared abduction brace and sling immobilization after arthroscopic rotator cuff repair using single-row, double-row, or suture-bridge fixation. Clinical scores, pain severity, and retear rates were compared between patients with abduction brace versus sling immobilization. RESULTS: Of 1572 retrieved studies, 4 RCTs with a total of 224 patients (112 patients with abduction brace and 112 patients with sling) were included in the qualitative analysis, and 3 of the RCTs were included in the quantitative analysis (meta-analysis). There were no significant differences between the abduction brace and sling immobilization groups in the Constant-Murley score at 3 months (weighted mean difference [WMD], 0.26 [95% CI, –1.30 to 1.83]; P = .74; I (2) = 84%), 6 months (WMD, 1.91 [95% CI, –0.17 to 4.00]; P = .07; I (2) = 85%), and 12 months (WMD, 0.55 [95% CI, –1.37 to 2.47]; P = .57; I (2) = 0%); the visual analog scale score for pain at 1 week (WMD, 0.10 [95% CI, –0.20 to 0.41]; P = .51; I (2) = 0%), 3 weeks (WMD, –0.12 [95% CI, –0.34 to 1.00]; P = .29; I (2) = 0%), 6 weeks (WMD, –0.12 [95% CI, –0.30 to 0.06]; P = .20; I (2) = 0%), and 12 weeks (WMD, –0.13 [95% CI, –0.27 to 0.02]; P = .09; I (2) = 18%); or the retear rate at 3 months (risk ratio, 0.63 [95% CI, 0.09 to 4.23]; P = .64; Z = 0.47%) postoperatively. CONCLUSION: Our systematic review demonstrated a lack of significant differences between the abduction brace and sling immobilization groups regarding postoperative clinical scores, pain severity, and tendon healing.