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Two or more corticosteroid injections prior to rotator cuff repair may increase revision surgery risk
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According to recently published results, there was no association between a single shoulder corticosteroid injection within 1 year before rotator cuff repair and increased risk for revision surgery. However, there was an association between two or more injections and an increased risk of subsequent revision surgery.
“For patients with a known or suspected rotator cuff tear, the results of the study demonstrate that a single corticosteroid injection is safe and does not increase the risk of complications after a potential surgical repair,” Brian C. Werner, MD, told Healio.com/Orthopedics. “Multiple injections in the year prior to surgery are associated with a higher rate of failure requiring revision surgery, so surgeons should be cautious and consider conservative treatments other than injections or surgery before administering more injections.”
Researchers queried two administrative databases for patients who underwent arthroscopic rotator cuff repair and identified 110,567 patients from the Medicare database and 12,892 patients from a private insurance database. Investigators grouped patients into groups that received none, one, two or three more ipsilateral corticosteroid shoulder injections within 1 year before surgery. Ipsilateral revision arthroscopic, open rotator cuff repair or arthroscopic debridement was the outcome of interest for a rotator cuff tear diagnosis within 2 years of the initial surgery.
Results showed a single injection within the year prior to rotator cuff repair did not correlate with revision surgery in either database group. There was an association between two or more injections used and a significant increase in the risk for revision surgery in both database populations. – by Monica Jaramillo
Disclosures: Desai reports he receives support from Arthrex, Linvatec, Trice and Wolters Kluwer Health. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Edward V. Fehringer, MD
The study by Desai and colleagues reminds us of the potential deleterious effect of corticosteroid injections on rotator cuff tendons. The authors noted that, after studying nearly 123,000 cases of arthroscopic rotator cuff tear repairs from the Medicare and a private insurance database, two or more injections in a shoulder in the year prior to a rotator cuff repair was associated with a higher risk of revision repair surgery within the first 2 years following the index repair vs. shoulders that underwent no pre-rotator cuff repair injections. Although there are many uncontrolled variables in the study, including corticosteroid dosing, tear size and tendon quality, as well as the chance patients with larger tears and/or poorer quality tendons may have had more injections, one should be aware of the association and counsel patients that increased numbers of preoperative injections for rotator cuff disease may be associated with a higher risk of revision surgery following repair.
Columbus, Nebraska
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