Do Corticosteroid Injections Before or After Primary Rotator Cuff Repair Influence the Incidence of Adverse Events? A Subjective Synthesis

PURPOSE:

To determine the influence of corticosteroid injection (CSI) before or after primary rotator cuff repair (RCR) on the risk of (1) revision RCR, (2) retears, and (3) infections.

METHODS:

The Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, PubMed, EMBASE, and MEDLINE databases were queried in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Data pertaining to the use of CSI before or after primary RCR and adverse events were extracted. A subjective synthesis of these outcomes and bias was performed.

RESULTS:

A total of 10 studies including 240,976 patients were identified; 20.0% received a perioperative CSI. Of the 48,235 patients that received a CSI, 66.2% did so preoperatively, while 33.8% did so postoperatively. A total of 78 patients had both pre- and postoperative CSI. Three studies examined the influence of preoperative CSI on revision RCR; the incidence ranged from 3.8%-10.5% with preoperative CSI and 3.2%-3.4% for controls. Two of these studies analyzed outcomes of patients from the same databases over the same time period. Five studies examined the influence of postoperative CSI use on retears; the incidence ranged from 5.7%-19.0% in those who received postoperative CSI and 10.0%-18.4% for controls. Three studies examined the influence of CSI use on infection; two studies examined risk of infection after postoperative CSI use, which ranged from 0.0%-6.7% with CSI and 0.0%-0.5% for controls.

CONCLUSION:

The use of preoperative CSI could be associated with an increased risk of revision RCR. There was no conclusive data to suggest an increased risk of retear or infection with CSI use based off of a subjective synthesis of ranges. There is currently poor-quality literature surrounding this topic. Given that the current literature is limited and heterogenous, no definitive recommendations can be made on perioperative CSI use for RCR.