Miltenberg Benjamin, Martinazzi Brandon J, Monahan Peter F, Johns William L, Onor Gabriel, Faasuamalie Paige E, Toci Gregory R, Aynardi Michael C, Ciccotti Michael G
Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A..
Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
Arthroscopy. 2025 Jul;41(7):2214-2221. doi: 10.1016/j.arthro.2024.11.084. Epub 2024 Dec 2.
To compare the rate of additional shoulder surgery related to postoperative stiffness or tendon healing after primary rotator cuff repair between patients with a losartan prescription and without a losartan prescription.
The International Classification of Diseases, Tenth Revision, code M75.1 was used to identify all patients in the TriNetX Research Network with a rotator cuff tear diagnosis who underwent arthroscopic rotator cuff repair between January 1, 2015, and December 31, 2021. Patients were stratified into the losartan group (LG) and nonlosartan group (NLG) on the basis of whether they had a coded prescription for losartan within 1 year before surgery or 3 months after surgery. The 2 cohorts were propensity scored and matched to reduce confounding biases. Specifically, cohorts were matched on the basis of age, gender, obesity, nicotine use, hyperlipidemia, diabetes, hypertensive diseases, ischemic heart disease, heart failure and valvular disease, and peripheral arterial disease. The incidence of additional shoulder surgeries associated with stiffness and rotator cuff healing was analyzed and compared at 1-year and 2-year time points.
After propensity score matching, both the LG and NLG contained 3,970 patients. There was no difference in the rate of lysis of adhesions or manipulation under anesthesia at 1-or 2-year postoperatively between patients in the LG and LG. Patients in the LG were less likely undergo arthroscopic debridement (odds ratio 0.71; confidence interval 0.56-0.91; P = .006) and rotator cuff repair (odds ratio 0.71; confidence interval 0.58-0.87; P = .001) 1-year postoperatively than patients in the NLG group. At 1-year postoperatively, there was no difference in the rate of arthroplasty, arthroscopic synovectomy, and diagnostic arthroscopy between groups. At 2-year postoperatively, there was no difference in the rate of rotator cuff repair, arthroplasty, arthroscopic debridement, synovectomy, and diagnostic arthroscopy between groups.
Patients undergoing arthroscopic rotator cuff repair with or without a perioperative prescription for losartan had no significant difference in the rate of lysis of adhesions or manipulation under anesthesia at 1- or 2-year postoperatively, indicating that the antifibrotic properties of losartan may not have a clinically significant impact on shoulder stiffness after arthroscopic rotator cuff repair. However, patients with a prescription for losartan were less likely to undergo additional arthroscopic debridement and rotator cuff repair 1-year postoperatively than a matched cohort of patients without a prescription for losartan.
Level III, case control study.
比较有氯沙坦处方和无氯沙坦处方的患者在初次肩袖修复术后与术后僵硬或肌腱愈合相关的额外肩部手术发生率。
使用国际疾病分类第十版代码M75.1识别TriNetX研究网络中所有在2015年1月1日至2021年12月31日期间接受关节镜肩袖修复且诊断为肩袖撕裂的患者。根据患者在手术前1年内或手术后3个月内是否有氯沙坦的编码处方，将患者分为氯沙坦组（LG）和非氯沙坦组（NLG）。对这两个队列进行倾向评分匹配以减少混杂偏倚。具体而言，队列根据年龄、性别、肥胖、吸烟、高脂血症、糖尿病、高血压疾病、缺血性心脏病、心力衰竭和瓣膜疾病以及外周动脉疾病进行匹配。分析并比较1年和2年时间点与僵硬和肩袖愈合相关的额外肩部手术发生率。
经过倾向评分匹配后，LG组和NLG组均包含3970例患者。LG组和NLG组患者在术后1年或2年时粘连松解或麻醉下手法操作的发生率无差异。LG组患者术后1年接受关节镜清创术（优势比0.71；置信区间0.56 - 0.91；P = .006）和肩袖修复（优势比0.71；置信区间0.58 - 0.87；P = .001）的可能性低于NLG组患者。术后1年时，两组之间关节成形术、关节镜滑膜切除术和诊断性关节镜检查的发生率无差异。术后2年时，两组之间肩袖修复、关节成形术、关节镜清创术、滑膜切除术和诊断性关节镜检查的发生率无差异。
接受关节镜肩袖修复且围手术期有或无氯沙坦处方的患者在术后1年或2年时粘连松解或麻醉下手法操作的发生率无显著差异，这表明氯沙坦的抗纤维化特性可能对关节镜肩袖修复术后的肩部僵硬没有临床显著影响。然而，有氯沙坦处方的患者术后1年比匹配的无氯沙坦处方患者队列接受额外关节镜清创术和肩袖修复的可能性更小。
III级，病例对照研究。
