Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair—Is It Time to Rethink a Conservative Treatment Paradigm?

Woolf, Shane K.

doi:10.1016/j.arthro.2018.12.017

Cited by 10 publications

(7 citation statements)

References 12 publications

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“…Similarly, Baverel et al 4 showed that preoperative CSIs did not negatively affect the clinical scores or retear rates after RCR, as confirmed using ultrasound. Furthermore, Woolf 58 noted in an editorial commentary that RCR surgery immediately after CSIs was concerning. However, since high success rates after RCR have been reported in related studies, CSIs are only 1 of the various factors associated with retears after RCR.…”

Section: Discussionmentioning

confidence: 99%

Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections

Feng

Zhong

et al. 2023

Am J Sports Med

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Background: Corticosteroid injections (CSIs) are effective in alleviating pain in patients with rotator cuff tears, but controversy still exists regarding their potential adverse effects on clinical outcomes after rotator cuff repair. Purpose: To compare both the functional and the structural outcomes in patients who underwent arthroscopic rotator cuff repair with or without preoperative CSIs. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort study was carried out among patients who underwent arthroscopic rotator cuff repair for partial- and full-thickness tears between 2015 and 2019. The patients who received preoperative CSIs were included in the CSI group and compared with a group without preoperative CSIs (non-CSI group), matched at a ratio of 1:2 based on tear size, age, and follow-up time. Both functional evaluation and structural assessments using magnetic resonance imaging (MRI) were performed at the final follow-up. Clinical outcomes—including retear rate as the primary outcome; pain; functional scores including the Constant-Murley score, American Shoulder and Elbow Surgeons score, and Fudan University Shoulder Score; range of motion (ROM); tendon integrity; tendon healing type; and cartilage thickness—were compared between the 2 groups with a statistical significance of P < .05 and power of 0.9. Results: Thirty-one patients were included in the CSI group, and 62 were included in the non-CSI group. After a mean 3-year follow-up, the 2 groups demonstrated no significant differences in retear rate; visual analog scale for pain; shoulder functional scores; and active ROM including forward flexion, abduction, external rotation, and internal rotation. No significant differences were observed on postoperative MRI scans of the rotator cuff tendon (tendon integrity, healing type, residual tendon attachment area, etc), cartilage thickness, and muscle atrophy. Conclusion: No significant differences were found at a mean 3-year follow-up in the retear rates, pain, ROM, and glenohumeral structure on postoperative MRI scans after arthroscopic rotator cuff repair with or without preoperative CSIs.

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Section: Discussionmentioning

confidence: 99%

Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections

Feng

Zhong

et al. 2023

Am J Sports Med

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“…Corticosteroid exposure results in an increase in apoptotic cells and a decrease in cellular viability and cellular metabolism 18,22,25,36 (Table 2). Cellular viability was shown to be reduced 14 days after exposure but not at 21 days after a single dose.…”

Section: Molecularmentioning

confidence: 99%

Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies

Puzzitiello

Patel

Forlenza

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To evaluate the in vitro effects of corticosteroid injections (CSIs) on rotator cuff tendon (RCT). Methods: A systematic review of the MEDLINE database was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for all studies reporting on adverse biochemical and biomechanical effects of CSIs on RCT. Results: Sixteen studies were identified that had been published in the last 15 years on the effects of corticosteroids on RCTs. Eight of these studies were on human RCTs, 6 were on rat tendons, 1 considered both human and rat tendons, and 1 was on dog tendon. Five studies analyzed the effects of corticosteroids on the biomechanical properties of RCT or rotator cuff repair, whereas the remaining observed the cellular and molecular effects of CSIs on RCT. Corticosteroids suppress an inflammatory response, induce apoptosis, and have negative effects on collagen and tendon cell viability in RCTs. The mechanical properties, including load to failure of RCTs and rotator cuff repair anchor pull-out strength, also are decreased by CSIs. These in vitro effects appear to be transient as well as frequency and dose dependent. Conclusions: On a molecular level, CSIs decrease cellular proliferation, alter collagen and extracellular matrix composition, impede inflammatory pathways, decrease cellular viability, increase adipocyte differentiation, and increase apoptosis. These changes can be seen as early as 24 hours after corticosteroid exposure, last as long as 2 to 3 weeks, and are exacerbated by increased doses and decreased latency between doses. Biomechanical studies demonstrate that these changes result in decreased maximal load to failure, tendon stiffness, and suture anchor pull-out strength in rat shoulders up to 2 weeks but not at 3 and 4 weeks, post-CSI. Clinical Relevance: Shoulder subacromial steroid injection is common, and practitioners should be aware of results both positive and deleterious.R otator cuff tendon (RCT) pathology is the most common cause of shoulder pain. 1 Rotator cuff tendinosis, which refers to processes such as impingement, rotator cuff fraying, partial-thickness tears, and tendinitis, is a normal element of human aging. 1,2 While often asymptomatic, RCT pathology can be a source of pain and significantly impact patients' quality of life. 3 Corticosteroid injections (CSIs) into the subacromial space have served as a valuable treatment modality to the physician treating patients with RCT pathology refractory to conservative management, as they have demonstrated to improve symptoms in the short term. 3e6 However, CSIs have failed to consistently provide long-term pain relief, and recent studies suggest that CSIs may even predispose to worse longterm outcomes, such as pathologic progression or surgical failure. 4,5,7e9

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“…6 Repeat local steroid injections may have negative effects on tendon homeostasis, healing and future treatment outcomes for some patients. [11][12][13][14] Suprascapular nerve block (SSNB) injections may offer an effective alternative to local steroid injections for some patients, and there is growing interest in their use including within physiotherapy practice. 15,16 The suprascapular nerve is a mixed motor and sensory nerve that supplies approximately 70% of the sensory innervation to the shoulder complex.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

Smith

Liew

Johnson

et al. 2021

British Journal of Pain

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Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.

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Editorial Commentary: Steroid Injections Prior to Arthroscopic Rotator Cuff Repair—Is It Time to Rethink a Conservative Treatment Paradigm?

Cited by 10 publications

References 12 publications

Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections

Functional and Structural Outcomes After Arthroscopic Rotator Cuff Repair With or Without Preoperative Corticosteroid Injections

Adverse Impact of Corticosteroids on Rotator Cuff Tendon Health and Repair: A Systematic Review of Basic Science Studies

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

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