Sling Versus No Sling After Superior Rotator Cuff Repair: A Propensity Score Matched, Longitudinal, Observational Study at Mid-Term Follow-up

Alexandre Lädermann; Patrick J Denard; Philippe Collin; Xue Ling Chuong; Alberto Guizzi; Jeanni Zbinden; Hugo Bothorel

DOI: 10.70885/hmsj.2025.01.003

Abstract

Background: Patients who underwent arthroscopic rotator cuff repair are often required to wear a sling after surgery despite the known adverse effects of immobilization with the intention to protect the cuff repair. Short-term results have proved to have good clinical outcomes even without a sling. Purpose: This study aims to compare mid-term clinical and radiological outcomes after arthroscopic rotator cuff repair (RCR) with and without postoperative sling immobilization.Methods: We retrospectively analyzed a monocentric consecutive cohort of 378 patients scheduled for RCR of small to medium superior cuff tears into sling and no sling groups. A propensity score matching was used to create two groups (n=54) that shared comparable baseline and surgical characteristics. Passive mobilization in elevation and abduction were performed in both groups during the first four weeks after surgery. In the no sling group, active mobilization elbow at the side was allowed. Patients were evaluated both clinically and radiologically with ultrasound at last follow-up.Results: At six months follow-up, the two groups' return to work and satisfaction were similar. With a minimum follow-up of two years (mean 3.5±1.7 years), both groups exhibited comparable ROM, reported similar PROMs. Most of the patients in each group improved beyond the MCID in ASES score (85% vs. 85%, p=1.000). The healing rate was also similar in both groups (p=0.965), with only 4% of the patients who not healed (Sugaya 4 and 5) in each group.Conclusion: Outcomes between the sling and no-sling groups were similar at six months and three years. Therefore, mobilization early without sling after superior RCRs seems to be a safe and validated rehabilitation regimen.Level of Evidence: Level 3 (retrospective comparative prognostic trial)Keywords: Shoulder; Revision; Retear; Outcomes: Complications; Healing; Immobilization.https://doi.org/10.70885/hmsj.2025.01.003

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