Purpose
To identify any dose-dependent association between the use of subacromial corticosteroid
injections within a year before rotator cuff repair (RCR) and subsequent need for
revision rotator cuff surgery.
Methods
Two large administrative databases were queried for patients undergoing arthroscopic
RCR. A minimum of 1 year of preoperative database exposure and 2 years of postoperative
database follow-up were required for inclusion. Patients were stratified into groups
that received 0 (control), 1, 2, or 3 or more ipsilateral corticosteroid shoulder
injections within the year prior to RCR. The outcome of interest was ipsilateral revision
arthroscopic or open RCR or arthroscopic debridement for a diagnosis of rotator cuff
tear within 2 years of the index surgery. Revision rates were compared between groups
using a multivariate logistic regression analysis controlling for demographic and
comorbidity confounders.
Results
A total of 110,567 patients from the Medicare database and 12,892 patients from the
private insurance database were included. There was no association between a single
injection within the year prior to RCR and revision surgery in either cohort. The
use of 2 or more injections was associated with a significant increase in the risk
of requiring revision surgery in both the Medicare (odds ratio [OR], 2.76-3.26; P < .0001) and private insurance (OR, 2.53-2.87; P < .0001) populations.
Conclusions
A single shoulder injection within a year prior to arthroscopic RCR was not associated
with any increased risk of revision surgery; however, the administration of 2 or more
injections was associated with a substantially increased risk of subsequent revision
rotator cuff surgery (OR, 2.53-3.26). Although causality cannot be established on
the basis of this database review, caution is recommended when considering more than
1 shoulder corticosteroid injection in patients with potentially repairable rotator
cuff tears.
Level of Evidence
Level III, retrospective cohort study.
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Article info
Publication history
Published online: November 22, 2018
Accepted:
July 30,
2018
Received:
February 15,
2018
Footnotes
See commentary on page 51
The authors report the following potential conflicts of interest or sources of funding: J.S.D. receives support from Arthrex, Linvatec, Trice, and Wolters Kluwer Health. S.F.B. receives support from Arthrex, Biomet, DePuy, Springer, and Zimmer. B.C.W. receives support from Biomet. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: “Doctor, Are You Sure the Steroid Injection Won't Harm My Shoulder?” Perhaps We Should Stop Injecting Corticosteroids and Just Repair Those Rotator CuffsArthroscopyVol. 35Issue 1
- PreviewAnalysis of insurance records indicates that 2 or more corticosteroid injections before rotator cuff repair could triple the odds of revision. The cause-and-effect relationship cannot be ascertained because it remains unclear whether steroids worsen outcomes or are injected in shoulders that are worse to start with. Registry studies cannot adjust for lesional determinants of prognosis and should be interpreted with caution to avoid depriving patients from safe and simple treatments to delay or circumvent surgery.
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