Abstract
Objectives:
Rotator cuff pathology is a common problem, affecting approximately 17 million individuals in the US. Among professional and competitive athletes, only 49.9% have returned to play at the same level as before their injury. Initial treatment often includes corticosteroid injections, but some patients continue to have pain resulting in surgical treatment. Although steroids are the mainstay of conservative treatment, recent studies have shown concerns for increased rates of postoperative infections and revision surgeries after RCR. This study aimed to determine the effect of prior ipsilateral steroid injection on outcomes following arthroscopic rotator cuff repair.
Methods:
A retrospective chart review was performed on 295 patients who underwent rotator cuff repair by a single fellowship-trained orthopedic surgeon from 2017-2019. Of the 225 patients that met inclusion criteria and underwent analysis, 42 patients were in the injection group (IG) and 183 in the control group (CG). Demographics, range of motion (ROM), patient-reported pain and satisfaction (0- 10), subjective shoulder value (SSV), complications and reoperations were compared between groups. Delta ROM and strength were defined as postoperative ROM minus preoperative ROM. Complications were defined as reoperations, retears, or subsequent infection. Statistical analysis included chi-square and student t-tests.
Results:
The cohort consisted of 57.4% males with an average age of 58.3, BMI of 29.5, and mean follow-up of 7.3 months. The mean time from injection to surgery was 5.6 months. There were no significant differences in demographics between the injection and control group. Preoperatively, the injection group had a significantly greater median supraspinatus strength (p=0.002), summed strength (p=0.003), forward elevation (p=0.003), abduction (p=0.005), and active external rotation (p<0.001). This was specific to injections received within the 12 months before surgery. Postoperatively, there were no significant differences between the groups on measures of pain, shoulder function, shoulder strength, range of motion, or SSV. The frequency of complications was also comparable between the no injection and injection group, having similar rates of persistent pain, limited ROM or stiffness, numbness or tingling, weakness, cervicalgia, adhesions, retear, and upper extremity DVT, and postoperative infections.
Conclusions:
The results of our study indicate that ipsilateral shoulder injection within one year of arthroscopic rotator cuff repair improves preoperative functional outcomes, namely improvements in forward flexion, abduction, external rotation, and relative strength. Despite enhancements preoperatively, postoperative measures of strength, range of motion, and complications are comparable between groups, which persists when analyzing the timing and number of injections. These results support the use of subacromial corticosteroid injections as an effective conservative treatment prior to rotator cuff repair. However, there is still a lack of consensus on how close in proximity to surgery it is safe to receive an injection and what preoperative patient characteristics may be more likely to benefit from injection prior to surgery. Future studies are needed to assess the short-term impact of corticosteroid injections on outcomes of rotator cuff repair, particularly in athletes.