Early Versus Delayed Mobilization After Rotator Cuff Repair: A Systematic Review of Re-tear Rates, Pain, Function, and Range of Motion

Rotator cuff tears are among the most common musculoskeletal conditions, with surgical repair rates increasing substantially over recent decades. Despite advances in surgical technique, re-tear rates remain a significant concern, particularly for large and massive tears. Postoperative rehabilitation is a critical determinant of both tendon healing and functional recovery, yet there is no consensus on the optimal timing of active mobilization, with the central debate focusing on whether early motion reduces stiffness at the expense of higher re-tear rates or whether delayed immobilization provides superior tendon healing without compromising long-term function. A systematic search of PubMed (MEDLINE), the Cochrane Library (CENTRAL), and Google Scholar was conducted in February 2026, and studies comparing early active or passive mobilization (initiated within 1-4 weeks) with delayed mobilization (≥4-6 weeks of immobilization) after rotator cuff repair were included. Outcomes assessed included re-tear rates, pain measured using the visual analog scale (VAS), functional scores including the American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California, Los Angeles (UCLA) Shoulder Rating Scale, Western Ontario Rotator Cuff (WORC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, as well as range of motion. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for randomized controlled trials (RCTs), and the Newcastle-Ottawa Scale (NOS) for cohort studies, and certainty of evidence was evaluated narratively using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Twelve studies (10 RCTs and 2 cohort studies; total 1,255 patients) met the inclusion criteria. Nine studies reporting re-tear rates found no statistically significant difference between early and delayed mobilization groups. Pain outcomes were comparable in most studies, although two trials reported lower pain scores in the early mobilization group. Functional outcomes showed no significant long-term differences in the majority of studies, though several reported short-term advantages with early mobilization. Early mobilization consistently improved range of motion in the short term (6 weeks to 3 months), particularly forward flexion and external rotation, but these advantages generally diminished by 6-12 months. Overall, early active mobilization after rotator cuff repair does not appear to increase re-tear rates and provides short-term range of motion benefits compared with delayed mobilization, while long-term functional outcomes remain comparable between protocols, although caution may be warranted in patients with large tears and advanced fatty infiltration, supporting an individualized rehabilitation approach based on tear size and tissue quality.