Smith Justin T, Pill Stephan G, Eggert Kailey A, Brignull Calleigh G, Adams Kyle J, Wyland Douglas J, Tolan Stefan J, Thigpen Charles A, Kissenberth Michael J
Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC, USA.
Hawkins Foundation, Greenville, SC, USA.
JSES Int. 2023 Nov 23;8(1):75-79. doi: 10.1016/j.jseint.2023.10.013. eCollection 2024 Jan.
Corticosteroid injections (CSIs) can be an effective nonsurgical treatment for patients with rotator cuff tears. Recent large database studies have raised concern that CSI may result in a higher reoperation rate, increased infection risk, and worse outcome after arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate the reoperation rate, incidence of postoperative infection, and two-year outcomes of patients undergoing ARCR with and without the use of preoperative CSI.
An institutional database generated from fellowship-trained orthopedic sports surgeons was retrospectively queried for patients who underwent ARCR with a minimum of two-year follow-up. Inclusion criteria consisted of 1) primary full-thickness rotator cuff tear and 2) preoperative and minimum two-year patient-reported outcome measures (PROMs). Of the 219 patients identified, 134 patients had preoperative subacromial CSI administered within one year of ARCR. Reoperation rate, number of injections, Visual Analog Scale, American Shoulder and Elbow Surgeons Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey Physical Component Score/Mental Component Score were compared between groups at six months, one year, and two years. Chi-square and -tests were used to compare baseline differences, postoperative infections, and reoperations. A repeated measures Analyses of Covariance was used to measure differences between PROMs at each time point. Simple Analyses of Covariance were used for the two-year sub-analyses for patients receiving CSI within 90 days of surgery and if multiple preoperative CSI had been given (α ≤ 0.05).
There were no significant demographic differences between groups ( > .05). Preoperative use of subacromial CSI within one year prior to ARCR did not increase reoperation rate ( = .85) or impact PROMs at any timepoint. There were two reoperations during the study period in the CSI group (2 lysis of adhesions). No infections occurred in either cohort. No differences were found if injections were performed within 90 days of surgery or if more than one CSI was administered within the year prior to surgery ( > .05).
Our results show that preoperative CSI prior to primary ARCR did not increase risk of reoperation, infection, or influence PROMs with a minimum follow-up of 2 years.
皮质类固醇注射（CSIs）对于肩袖撕裂患者可能是一种有效的非手术治疗方法。最近的大型数据库研究引发了人们的担忧，即皮质类固醇注射可能导致更高的再次手术率、增加感染风险以及在关节镜下肩袖修复术（ARCR）后出现更差的预后。本研究的目的是评估接受ARCR的患者在术前使用或未使用CSIs情况下的再次手术率、术后感染发生率以及两年的预后情况。
对由接受过专科培训的骨科运动外科医生建立的机构数据库进行回顾性查询，以获取接受ARCR且至少随访两年的患者。纳入标准包括：1）原发性全层肩袖撕裂；2）术前及至少两年的患者报告结局指标（PROMs）。在确定的219例患者中，134例患者在ARCR前一年内接受了术前肩峰下CSIs注射。比较两组在6个月、1年和2年时的再次手术率、注射次数、视觉模拟评分、美国肩肘外科医生评分、单项评估数值评定以及退伍军人兰德12项健康调查身体成分评分/精神成分评分。采用卡方检验和t检验比较基线差异、术后感染和再次手术情况。使用重复测量协方差分析来测量每个时间点PROMs之间的差异。对于在手术90天内接受CSIs注射的患者以及如果术前给予多次CSIs注射的患者，使用简单协方差分析进行两年的亚组分析（α≤0.05）。
两组之间在人口统计学方面无显著差异（P>0.05）。在ARCR前一年内术前使用肩峰下CSIs并未增加再次手术率（P=0.85），也未在任何时间点影响PROMs。在研究期间，CSIs组有2例再次手术（2例粘连松解）。两组均未发生感染。如果在手术90天内进行注射或在手术前一年给予多次CSIs注射，未发现差异（P>0.05）。
我们的结果表明，在初次ARCR前进行术前CSIs注射，在至少2年的随访中，并未增加再次手术风险、感染风险或影响PROMs。
