Purpose
To assess the effect of teriparatide, a recombinant human parathyroid hormone, on
rotator cuff healing after arthroscopic repair compared with patients who were not
treated with teriparatide.
Methods
This was a prospective propensity-matched study. Thirty-one patients who underwent
arthroscopic rotator cuff repair for tears >2 cm in size between January 2015 and
June 2016 were recruited (group I). Daily subcutaneous injections of teriparatide
20 μg were administered for 3 months following surgery. In the same period, propensity
score matching (1-to-4) was performed to generate an untreated control group undergoing
rotator cuff repair alone (group II) with the same tear size. Magnetic resonance imaging
evaluation of tendon healing was performed at least 1 year postoperatively, as well
as the range of shoulder motion, American Shoulder and Elbow Surgeons score, Constant
score, and simple shoulder test.
Results
There was no significant difference of the retraction size, the anterior to posterior
dimension of torn rotator cuff, or the preoperative bone mineral density in groups
I and II (P = .78, .87, and .96, respectively). The rate of retear was significantly lower in
group I than in group II (16% vs 33.9%; P = .04). Range of motion and functional scores were not significantly different between
the 2 groups (P > .05).
Conclusions
Teriparatide, a recombinant human parathyroid hormone, can be a systemic treatment
option that significantly enhances the tendon-to-bone healing after arthroscopic rotator
cuff repair for patients with rotator cuff tears >2 cm.
Level of Evidence
Level III, case-control study.
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References
- Massive rotator cuff tears: Debridement versus repair.Orthop Clin N Am. 1997; 28: 117-124
- Outcome and structural integrity of rotator cuff after arthroscopic treatment of large and massive tears with double row technique: A 2-year followup.Advances Orthop. 2013; 2013: 914148
- Arthroscopic repair of massive rotator cuff tears: Outcome and analysis of factors associated with healing failure or poor postoperative function.Am J Sports Med. 2013; 41: 1674-1683
- The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.J Bone Joint Surg Am. 2004; 86: 219-224
- Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors.Am J Sports Med. 2011; 39: 2099-2107
- Does footprint preparation influence tendon-to-bone healing after rotator cuff repair in an animal model?.Arthroscopy. 2014; 30: 188-194
- 2013 Neer Award: Effect of the adipose-derived stem cell for the improvement of fatty degeneration and rotator cuff healing in rabbit model.J Shoulder Elbow Surg. 2014; 23: 445-455
- Effect of platelet-rich plasma and porcine dermal collagen graft augmentation for rotator cuff healing in a rabbit model.Am J Sports Med. 2013; 41: 2909-2918
- Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses.Arthroscopy. 2016; 32: 906-918
- Effects of allogenic dermal fibroblasts on rotator cuff healing in a rabbit model of chronic tear.Am J Sports Med. 2018; 46: 1901-1908
- Stem cell therapy in the management of shoulder rotator cuff disorders.World J Stem Cells. 2015; 7: 691-699
- Skeletal actions of intermittent parathyroid hormone: effects on bone remodelling and structure.Bone. 2007; 40: 1447-1452
- Delayed administration of recombinant human parathyroid hormone improves early biomechanical strength in a rat rotator cuff repair model.J Shoulder Elbow Surg. 2016; 25: 1280-1287
- Intermittently administered parathyroid hormone [1-34] promotes tendon-bone healing in a rat model.Int J Mol Sci. 2014; 15: 17366-17379
- Parathyroid hormone 1-34 enhances extracellular matrix deposition and organization during flexor tendon repair.J Orthop Res. 2015; 33: 17-24
- The effect of rhPTH on the healing of tendon to bone in a rat model.J Orthop Res. 2012; 30: 769-774
- Dual role of parathyroid hormone in endothelial progenitor cells and marrow stromal mesenchymal stem cells.J Cell Physiol. 2010; 222: 474-480
- Prognostic factors affecting rotator cuff healing after arthroscopic repair in small to medium-sized tears.Am J Sports Med. 2015; 43: 2386-2392
- Dislocation arthropathy of the shoulder.J Bone Joint Surg Am. 1983; 65: 456-460
- Muscle cramps and weakness after teriparatide therapy: A new drug-induced myopathy?.Muscle Nerve. 2013; 47: 615
- Site and size of rotator-cuff tear. Findings at ultrasound, double-contrast arthrography, and computed tomography arthrography with surgical correlation.Invest Radiol. 1996; 31: 387-394
- Validation of clinical examination versus magnetic resonance imaging and arthroscopy for the detection of rotator cuff lesions.Clin Rheumatol. 2013; 32: 1283-1291
- Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.J Shoulder Elbow Surg. 2003; 12: 550-554
- Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation.Arthroscopy. 2005; 21: 1307-1316
- Goniometric assessment of shoulder range of motion: Comparison of testing in supine and sitting positions.Arch Phys Med Rehab. 1998; 79: 647-651
- Isokinetic muscle performance test can predict the status of rotator cuff muscle.Clin Orthop Rel Res. 2010; 468: 1506-1513
- PTHrP regulates growth plate chondrocyte differentiation and proliferation in a Gli3 dependent manner utilizing hedgehog ligand dependent and independent mechanisms.Devel Biol. 2007; 305: 28-39
- Contribution of PTHrP to mechanical strain-induced fibrochondrogenic differentiation in entheses of Achilles tendon of miniature pigs.J Biomechanics. 2014; 47: 2406-2414
- Impact of growth factors and PTHrP on early and late chondrogenic differentiation of human mesenchymal stem cells.J Cell Physiol. 2010; 223: 84-93
- Structural integrity after rotator cuff repair does not correlate with patient function and pain: A meta-analysis.J Bone Joint Surg Am. 2014; 96: 265-271
- Evaluation of persistence and adherence to teriparatide treatment in patients affected by severe osteoporosis (PATT): A multicenter observational real life study.Clin Cases Mineral Bone Metab. 2013; 10: 56-60
- Assessing compliance, acceptance, and tolerability of teriparatide in patients with osteoporosis who fractured while on antiresorptive treatment or were intolerant to previous antiresorptive treatment: An 18-month, multicenter, open-label, prospective study.Clin Ther. 2007; 29: 2055-2067
- Teriparatide induced delayed persistent hypercalcemia.Case Rep Endocrinol. 2014; 2014: 802473
- Retear rate in the late postoperative period after arthroscopic rotator cuff repair.Am J Sports Med. 2014; 42: 2606-2613
- Experimental rotator cuff repair. A preliminary study.J Bone Joint Surg Am. 1999; 81: 1281-1290
- Effects of teriparatide, alendronate, or both in women with postmenopausal osteoporosis.J Clin Endocrinol Metab. 2010; 95: 1838-1845
Article Info
Publication History
Published online: March 08, 2019
Accepted:
November 12,
2018
Received:
July 8,
2018
Footnotes
See commentary on page 1072
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
