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Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery

OBJECTIVES: Subacromial steroid injections are frequently used in the initial conservative management of rotator cuff (RC) tears, however, the long-term effect of this treatment in patients who eventually undergo rotator cuff repair (RCR) is not well defined in the literature. The objective of this...

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Autores principales: Desai, Vishal Shwetal, Camp, Christopher L., Cancienne, Jourdan M., Dines, Joshua S., Brockmeier, Stephen F., Werner, Brian C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083764/
http://dx.doi.org/10.1177/2325967118S00081
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author Desai, Vishal Shwetal
Camp, Christopher L.
Cancienne, Jourdan M.
Dines, Joshua S.
Brockmeier, Stephen F.
Werner, Brian C.
author_facet Desai, Vishal Shwetal
Camp, Christopher L.
Cancienne, Jourdan M.
Dines, Joshua S.
Brockmeier, Stephen F.
Werner, Brian C.
author_sort Desai, Vishal Shwetal
collection PubMed
description OBJECTIVES: Subacromial steroid injections are frequently used in the initial conservative management of rotator cuff (RC) tears, however, the long-term effect of this treatment in patients who eventually undergo rotator cuff repair (RCR) is not well defined in the literature. The objective of this study is to identify any dose-dependent association between injections prior to rotator cuff repair (RCR) and subsequent revision surgery. METHODS: Two large databases were queried for patients undergoing arthroscopic RCR. Patients with one year of pre-operative database exposure and a minimum of two years post-operative follow-up were included. In each database, three study groups were formed, stratified by the number of ipsilateral injections given within the year prior to RCR: one, two and three or more injections. A control group without any prior injection was identified and matched to the single injection group in each database. The outcome of interest was ipsilateral revision arthroscopic or open rotator cuff repair, or arthroscopic debridement for a diagnosis of rotator cuff tear within 2 years of the index surgery. Revision surgery rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders. This allowed for identification of the independent association between the number of injections and the need for subsequent revision surgery. RESULTS: 108,516 patients from the Medicare database and 11,360 patients from the private database were included (Table 1A-B). There was no association between a single injection within the year prior to RCR and revision surgery in either database. In the Medicare database, two or more injections was associated with a substantial increase in the risk of requiring revision surgery (OR 2.40-2.62, P < 0.0001). A similar association was noted in the private insurance database for patients with two or more injections (OR 2.09-2.42, P < 0.0001) (Table 1A-B). CONCLUSION: A single shoulder injection within a year prior to arthroscopic RCR is not associated with any increased risk of revision surgery. Two or more injections within a year prior to RCR appears to be associated with a substantially increased risk of revision surgery. While causality cannot be established on the basis of this database review, caution is recommended when considering more than one shoulder injection in patients with potentially repairable RC tears.
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spelling pubmed-60837642018-08-14 Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery Desai, Vishal Shwetal Camp, Christopher L. Cancienne, Jourdan M. Dines, Joshua S. Brockmeier, Stephen F. Werner, Brian C. Orthop J Sports Med Article OBJECTIVES: Subacromial steroid injections are frequently used in the initial conservative management of rotator cuff (RC) tears, however, the long-term effect of this treatment in patients who eventually undergo rotator cuff repair (RCR) is not well defined in the literature. The objective of this study is to identify any dose-dependent association between injections prior to rotator cuff repair (RCR) and subsequent revision surgery. METHODS: Two large databases were queried for patients undergoing arthroscopic RCR. Patients with one year of pre-operative database exposure and a minimum of two years post-operative follow-up were included. In each database, three study groups were formed, stratified by the number of ipsilateral injections given within the year prior to RCR: one, two and three or more injections. A control group without any prior injection was identified and matched to the single injection group in each database. The outcome of interest was ipsilateral revision arthroscopic or open rotator cuff repair, or arthroscopic debridement for a diagnosis of rotator cuff tear within 2 years of the index surgery. Revision surgery rates were compared between groups using a multivariate logistic regression analysis controlling for demographic and comorbidity confounders. This allowed for identification of the independent association between the number of injections and the need for subsequent revision surgery. RESULTS: 108,516 patients from the Medicare database and 11,360 patients from the private database were included (Table 1A-B). There was no association between a single injection within the year prior to RCR and revision surgery in either database. In the Medicare database, two or more injections was associated with a substantial increase in the risk of requiring revision surgery (OR 2.40-2.62, P < 0.0001). A similar association was noted in the private insurance database for patients with two or more injections (OR 2.09-2.42, P < 0.0001) (Table 1A-B). CONCLUSION: A single shoulder injection within a year prior to arthroscopic RCR is not associated with any increased risk of revision surgery. Two or more injections within a year prior to RCR appears to be associated with a substantially increased risk of revision surgery. While causality cannot be established on the basis of this database review, caution is recommended when considering more than one shoulder injection in patients with potentially repairable RC tears. SAGE Publications 2018-07-27 /pmc/articles/PMC6083764/ http://dx.doi.org/10.1177/2325967118S00081 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
spellingShingle Article
Desai, Vishal Shwetal
Camp, Christopher L.
Cancienne, Jourdan M.
Dines, Joshua S.
Brockmeier, Stephen F.
Werner, Brian C.
Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title_full Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title_fullStr Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title_full_unstemmed Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title_short Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery
title_sort increasing numbers of pre-operative shoulder injections are associated with a higher rate of subsequent revision rotator cuff surgery
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6083764/
http://dx.doi.org/10.1177/2325967118S00081
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