Timing of corticosteroid injection within 1 year prior to rotator cuff repair was not associated with increased risk of repair failure.

BACKGROUND

Nonoperative management of atraumatic rotator cuff tears often includes corticosteroid injection (CSI). Concerns persist regarding CSI effect on tendon quality and rotator cuff repair (RCR) outcomes, though how timing of a single CSI influences RCR outcomes is unclear. This study evaluated whether CSI timing within 1 year before RCR affects repair failure, patient-reported outcomes (PROs), range of motion (ROM), and strength, compared to patients undergoing RCR without CSI. We hypothesized that CSI within 3 months of RCR would lead to higher failure rates and worse outcomes.

METHODS

This retrospective study examined consecutive adult patients undergoing primary RCR from 2015 to 2022 at 1 institution. Inclusion criteria were nonoperative management of an atraumatic rotator cuff tear ≥6 weeks and minimum 1-year follow-up. Exclusion criteria included prior shoulder surgery and traumatic injury. Patients with preoperative CSI were grouped by CSI timing before RCR: <3 months, 3-6 months, and 6 months-1 year. Primary outcome was repair failure (reoperation or magnetic resonance imaging-confirmed retear). Magnetic resonance imaging was performed only in patients with symptoms suggesting recurrent cuff pathology. Secondary outcomes included PROs (Subjective Shoulder Value, Patient-Reported Outcomes Measurement Information System scores, American Shoulder and Elbow Surgeons score, visual analog scale [VAS]), strength, and ROM.

RESULTS

Overall, 198 patients were included; 89 patients without preoperative CSI (controls), 44 with CSI within 3 preoperative months, 34 with CSI 3-6 months prior, and 31 with CSI 6-12 months prior. Mean ages were 59 (controls), 59 (CSI <3 months), 63 (CSI 3-6 months), and 57 years (CSI 6-12 months) (P = .13). Demographics, follow-up length, RCR technique, and tendons involved were comparable across groups (all P > .05). Overall repair failure was 24%, with 19% failure in patients who received CSI. Group failure rates were 30% (controls), 20% (<3 months), 18% (3-6 months), and 19% (6 months-1 year) (P = .34). Postoperative improvements were similar between all groups for visual analog scale (3 vs. 4 points, P > .05), Subjective Shoulder Value (21% vs. 29%, P > .05), and American Shoulder and Elbow Surgeons scores (15 vs. 12 points, P > .05). Postoperative external rotation decreased by 4° among all CSI patients (P = .02) but increased by 3° in controls. Postoperative PROs, ROM, and strength were similar between groups.

CONCLUSION

This study demonstrated comparable outcomes for patients receiving CSI within 1 year of RCR and control patients. Timing of 1 preoperative CSI within 1 year of RCR did not significantly affect failure, PROs, ROM, or strength, suggesting that 1 CSI before RCR does not strongly influence outcomes.