Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.
Arthroscopy. 2019 Jan;35(1):45-50. doi: 10.1016/j.arthro.2018.07.043. Epub 2018 Nov 22.
To identify any dose-dependent association between the use of subacromial corticosteroid injections within a year before rotator cuff repair (RCR) and subsequent need for revision rotator cuff surgery.
Two large administrative databases were queried for patients undergoing arthroscopic RCR. A minimum of 1 year of preoperative database exposure and 2 years of postoperative database follow-up were required for inclusion. Patients were stratified into groups that received 0 (control), 1, 2, or 3 or more ipsilateral corticosteroid shoulder injections within the year prior to RCR. The outcome of interest was ipsilateral revision arthroscopic or open RCR or arthroscopic debridement for a diagnosis of rotator cuff tear within 2 years of the index surgery. Revision rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders.
A total of 110,567 patients from the Medicare database and 12,892 patients from the private insurance database were included. There was no association between a single injection within the year prior to RCR and revision surgery in either cohort. The use of 2 or more injections was associated with a significant increase in the risk of requiring revision surgery in both the Medicare (odds ratio [OR], 2.76-3.26; P < .0001) and private insurance (OR, 2.53-2.87; P < .0001) populations.
A single shoulder injection within a year prior to arthroscopic RCR was not associated with any increased risk of revision surgery; however, the administration of 2 or more injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery (OR, 2.53-3.26). Although causality cannot be established on the basis of this database review, caution is recommended when considering more than 1 shoulder corticosteroid injection in patients with potentially repairable rotator cuff tears.
Level III, retrospective cohort study.
确定在肩袖修补术（RCR）前一年内使用肩峰下皮质类固醇注射与随后需要进行翻修肩袖手术之间是否存在剂量依赖性关联。
对接受关节镜 RCR 的患者进行了两个大型行政数据库查询。纳入标准为患者至少有 1 年的术前数据库暴露和 2 年的术后数据库随访。患者分为在 RCR 前一年内接受 0（对照组）、1、2 或 3 次或更多同侧皮质类固醇肩部注射的组。感兴趣的结果是同侧翻修关节镜或开放式 RCR 或关节镜下清创术，用于诊断索引手术后 2 年内的肩袖撕裂。使用多变量逻辑回归分析控制人口统计学和合并症混杂因素，比较组间的翻修率。
从医疗保险数据库中纳入了 110567 例患者，从私人保险数据库中纳入了 12892 例患者。在两个队列中，RCR 前一年内单次注射与翻修手术均无关联。在医疗保险（比值比 [OR]，2.76-3.26；P<0.0001）和私人保险（OR，2.53-2.87；P<0.0001）人群中，使用 2 次或更多次注射与需要翻修手术的风险显著增加相关。
在关节镜 RCR 前一年内进行单次肩部注射与翻修手术风险增加无关；然而，给予 2 次或更多次注射与随后进行翻修肩袖手术的风险显著增加相关（OR，2.53-3.26）。尽管基于本数据库回顾无法确定因果关系，但对于可能需要修复的肩袖撕裂患者，在考虑进行超过 1 次肩部皮质类固醇注射时应谨慎。
III 级，回顾性队列研究。
