Should Rotator Cuff Surgery Be Delayed In Patients Receiving Shoulder Injections?
A corticosteroid injection within 6 months of rotator cuff repair puts patients at a significantly increased risk for revision repair, according to a recently published study.
Jonathan D. Haskel, MD, and Kirk A. Campbell, MD
Traven SA, Brinton D, Simpson KN, et al. Preoperative shoulder injections are associated with increased risk of revision rotator cuff repair. Arthroscopy. 2019 Mar;35(3):706-713. doi: 10.1016/j.arthro.2018.10.107. Epub 2019 Feb 4.
Animal studies support the notion that corticosteroid injections can lead to pathologic changes in tendon and collagen architecture. However, studies that examine clinically deleterious effects of injections in the rotator cuffs of humans are limited.
In a retrospective database analysis, Traven et al identified approximately 5000 pateints who, between 2010 and 2014:
- Received a corticosteroid injection in the shoulder
- Subsequently underwent an ipsilateral arthroscopic rotator cuff repair (RCR) within 12 months of the injection.
More than 390 patients required revision RCR within 3 years of the index procedure. Patients who received an injection in the 6 months preceding the index surgery were at a significantly higher risk of revision RCR than those who received an injection more than 6 months before surgery.
The odds ratios for revision RCR were as follows:
- Injection 0 to 3 months before primary RCR: 1.375
- Injection 3 to 6 months before primary RCR: 1.822
- Injection 6 to 12 months before primary RCR: 1.237
Increasing age, male sex, being a smoker, and having diabetes mellitus were also found to be significantly associated with a revision procedure.
Shoulder injection is one of the most common office procedures performed by sports medicine surgeons. Many patients have lasting pain relief from these injections; however, it behooves the surgeon to have a keen understanding of the effects of corticosteroid injections.
As clinicians, we are compelled to provide pain relief for patients with debilitating symptomatic rotator cuff tears. If these patients are candidates for RCR, however, they have a significant risk of reoperation associated with preoperative injections, and this risk may be time-dependent.
The study by Traven et al should prompt clinicians to consider other pain management strategies, such as oral non-steroidal anti-inflammatory drugs, and to consider pausing usage of corticosteroid injections in the shoulders of patients who are candidates for arthroscopic RCR.
Jonathan D. Haskel, MD, is a resident physician at NYU Langone Orthopedic Hospital, New York, New York. Kirk A. Campbell, MD, is an Assistant Professor of Orthopedic Surgery, Division of Sports Medicine, at NYU Langone Orthopedic Hospital, New York, New York.
The authors have no disclosures relevant to this article