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Cimino AM, Veazey GC, McMurtrie JT, et al. Corticosteroid Injections May Increase Retear and Revision Rates of Rotator Cuff Repair: A Systematic Review. Arthroscopy. 2020 Aug;36(8):2334-2341. doi: 10.1016/j.arthro.2020.04.044. Epub 2020 May 8. (Systematic review)
Abstract

PURPOSE: To synthesize the clinical outcome data of preoperative and postoperative corticosteroid injections (CIs) and their effect on rotator cuff repairs (RCRs).

METHODS: A systematic review was performed to identify studies that reported the results or clinical outcomes of RCRs in patients receiving either preoperative or postoperative CIs. The searches were performed using MEDLINE, Google Scholar, and Embase, and studies were chosen following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines.

RESULTS: A total of 11 studies were included with data for 176,352 shoulders: 6 studies involving 175,256 shoulders with data regarding preoperative CIs, 4 studies involving 1,096 shoulders with data regarding postoperative CIs, and 1 study with 212 shoulders containing preoperative and postoperative data. Preoperative CIs were found in 3 studies to increase the risk of revision surgery when administered within 6 months (odds ratio [OR], 1.38-1.82) and up to 1 year (OR, 1.12-1.52) prior to RCR, with revision rates in 2 studies being highest when patients received 2 or more injections (OR, 2.12-3.26) in the prior year. Postoperative CIs reduced pain and improved functional outcomes in 5 studies without increasing the retear rates (5.7%-19% for CI and 14%-18.4% for control) in most studies.

CONCLUSIONS: CIs provide benefit by relieving pain and improving functional outcome scores. However, repeated preoperative CIs may increase retear rates and the likelihood of revision surgery. A lower frequency of CI and longer preoperative waiting period after CI should be considered to decrease such risks. Postoperative CIs several weeks after RCR do not appear to increase retear rates.

LEVEL OF EVIDENCE: Level IV, systematic review of Level I through IV studies.

Ratings
Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

The review shows an association between corticosteroid injection before surgery repair of the tendon and successive revision surgery. This fact is in accordance with the deleterious effect of corticosteroid injection on the biomecanical strenght of the site of insertion and on the tendon integrity, shown in previous studies. Less deleterious semms to be the postoperative treatment.

Physician rater

Corticosteroid injections (CI) are very useful in managing pain in rotator cuff tears. Some of these patients need surgical repair after CI. Thus the information provided in the review demonstrates that, the surgical repair should wait after the CI effect is completely gone to lower the risk of complications.
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